Multifocality in Retroperitoneal Sarcoma

Anaya, Daniel A.; Lahat, Guy; Lee, Jun; Xing, Yan; Cormier, Janice N.; Pisters, Peter W.T.; Lev, Dina; Pollock, Raphael E.

doi:10.1097/sla.0b013e3181928f2f

Cited by 113 publications

(35 citation statements)

References 27 publications

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“…Prolonged disease free intervals can be observed in patients with a limited number of sites of disease and late recurrences, but multifocality is associated with poor outcomes. 50 A recent review of patients presenting with recurrence after complete resection of a liposarcoma demonstrates that rate of recurrence is also an important prognostic factor. Patients whose tumors recur at a rate of greater than one centimeter per month after complete gross resection do poorly.…”

Section: Management Of Abdominal and Retroperitoneal Tumorsmentioning

confidence: 99%

Principles in Management of Soft Tissue Sarcoma

Crago

Brennan

2015

Advances in Surgery

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Section: Management Of Abdominal and Retroperitoneal Tumorsmentioning

confidence: 99%

Principles in Management of Soft Tissue Sarcoma

Crago

Brennan

2015

Advances in Surgery

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“…Factors reportedly associated with a longer survival after salvage surgery for RP sarcomas in general are a long recurrence-free interval, 11 unifocal disease, 12 and complete resection. 7 Park et al reported that a slow tumor growth rate after recurrence (<0.9 cm/month) was predictive for longer disease-free survival (DFS) in recurrent RP liposarcomas.…”

Section: Introductionmentioning

confidence: 99%

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

et al. 2018

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Purpose Current evidence regarding salvage resection for recurrent retroperitoneal (RP) sarcomas generally lacks detailed histology-specific analyses, but the aggressiveness of these tumors varies widely by histology. We investigated associations between timing and extent of salvage surgery and survival outcomes in patients with recurrent RP well-differentiated liposarcoma (WDLPS). Methods The University of Texas MD Anderson Cancer Center Surgical Oncology sarcoma database was reviewed to identify patients with RP WDLPS who underwent surgical resection for 1st recurrent disease (salvage surgery) in 1995–2015. Medical records were retrospectively reviewed to identify factors associated with overall survival (OS) and disease-free survival (DFS). Results We identified 52 patients who underwent salvage surgery for RP WDLPS for 1st local recurrence; 28 (54%) underwent salvage surgery within 6 months after recurrence. Concomitant organ resections were performed in 32 (62%) patients, 4 (13%) of whom had pathologic invasion of resected organs. After R0/R1 resections (n=45), 38 (84%) experienced a 2nd local recurrence. Multivariable analyses revealed that organ invasion at the primary surgery (HR 13.08; p=0.005) and disease-free interval <1 year (HR 3.64; p=0.044) were associated with shorter OS. Recurrence-to-salvage interval <6 months was associated with shorter DFS (HR 2.18; p=0.025). Concomitant organ resection was associated with a longer hospital stay, ≥14 days (OR 21.58; p=0.007). Conclusions Early salvage surgery may not always be the best approach for recurrent RP WDLPS patients. Since organ invasion is rare among recurrent RP WDLPS patients and concomitant organ resection is associated with a longer hospital stay, preservation of uninvolved organs should be considered.

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“…31–34 For local recurrence of WD-LPS within the field of previous resection(s), the surgeon may rationally wait for an increase in tumor size in order to space out the interval between operations (IVB). 35 …”

Section: Resultsmentioning

confidence: 99%

Management of Recurrent Retroperitoneal Sarcoma (RPS) in the Adult: A Consensus Approach from the Trans-Atlantic RPS Working Group

2016

Ann Surg Oncol

145

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Introduction Retroperitoneal soft tissue sarcomas (RPS) are rare tumors. Surgery is the mainstay of curative therapy, but local recurrence is common. No recommendations concerning the best management of recurring disease have been developed so far. Although every effort should be made to optimize the initial approach, recommendations to treat recurring RPS will be helpful to maximize disease control at recurrence. Methods An RPS transatlantic working group was established in 2013. The goals of the group were to share institutional experiences, build large multi-institutional case series, and develop consensus documents on the approach to this difficult disease. The outcome of this document applies to recurrent RPS that is nonvisceral in origin. Included are sarcomas of major veins, undifferentiated pleomorphic sarcoma of psoas, ureteric leiomyosarcoma (LMS). Excluded are desmoids-type fibromatosis, angiomyolipoma, gastrointestinal stromal tumors, sarcomas arising from the gut or its mesentery, uterine LMS, prostatic sarcoma, paratesticular/spermatic cord sarcoma, Ewing sarcoma, alveolar/embryonal rhabdomyosarcoma, sarcoma arising from teratoma, carcinosarcoma, sarcomatoid carcinoma, clear cell sarcoma, radiation-induced sarcoma, paraganglioma, and malignant pheochromocytoma. Results Recurrent RPS management was evaluated from diagnosis to follow-up. It is a rare and complex malignancy that is best managed by an experienced multidisciplinary team in a specialized referral center. The best chance of cure is at the time of primary presentation, but some patients may experience prolonged disease control also at recurrence, when the approach is optimized and follows the recommendations contained herein. Conclusions International collaboration is critical for adding to the present knowledge. A transatlantic prospective registry has been established.

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Multifocality in Retroperitoneal Sarcoma

Abstract: Multifocal RPS is associated with worse OS in patients with either primary or recurrent RPS; Patients with >7 tumors had the worst prognosis. This criterion can be used to define sarcomatosis, thereby identifying patients whose survival will ultimately depend on effective systemic therapy.

Cited by 113 publications

References 27 publications

Principles in Management of Soft Tissue Sarcoma

Principles in Management of Soft Tissue Sarcoma

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

Management of Recurrent Retroperitoneal Sarcoma (RPS) in the Adult: A Consensus Approach from the Trans-Atlantic RPS Working Group

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