Perioperative radiotherapy versus surgery alone for retroperitoneal sarcomas: a systematic review and meta-analysis

Diamantis, Alexandros; Baloyiannis, Ioannis; Magouliotis, Dimitrios; Tolia, Maria; Symeonidis, Dimitrios; Bompou, Effrosyni; Polymeneas, G.; Tepetes, Konstantinos

doi:10.2478/raon-2020-0012

Cited by 34 publications

(24 citation statements)

References 29 publications

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“…In extremity STS, pre- and post-operative RT have equivalent local control and overall survival outcomes [ 2 , 3 , 4 ]. Thus, pre-operative RT is often preferred as patients developed fewer long-term irreversible RT complications than those who received post-operative radiotherapy [ 5 , 6 , 7 ]. Nonetheless, pre-operative RT in STS management seldom results in tumour shrinkage, except for certain subtypes such as myxoid liposarcomas [ 8 , 9 , 10 , 11 ], and serves mainly to decontaminate the microscopic diseases surrounding the visible tumour.…”

Section: Introductionmentioning

confidence: 99%

Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells

Lafontaine

Cardin

Malaquin

et al. 2021

Cancers

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Radiotherapy (RT) is a key component of cancer treatment. Most of the time, radiation is given after surgery but for soft-tissue sarcomas (STS), pre-surgical radiation is commonly utilized. However, despite improvements in RT accuracy, the rate of local recurrence remains high and is the major cause of death for patients with STS. A better understanding of cell fates in response to RT could provide new therapeutic options to enhance tumour cell killing by RT and facilitate surgical resection. Here, we showed that irradiated STS cell cultures do not die but instead undergo therapy-induced senescence (TIS), which is characterized by proliferation arrest, senescence-associated β-galactosidase activity, secretion of inflammatory cytokines and persistent DNA damage. STS-TIS was also associated with increased levels of the anti-apoptotic Bcl-2 family of proteins which rendered cells targetable using senolytic Bcl-2 inhibitors. As oppose to radiation alone, the addition of senolytic agents Venetoclax (ABT-199) or Navitoclax (ABT-263) after irradiation induced a rapid apoptotic cell death in STS monolayer cultures and in a more complex three-dimensional culture model. Together, these data suggest a new promising therapeutic approach for sarcoma patients who receive neoadjuvant RT. The addition of senolytic agents to radiation treatments may significantly reduce tumour volume prior to surgery and thereby improve the clinical outcome of patients.

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Section: Introductionmentioning

confidence: 99%

Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells

Lafontaine

Cardin

Malaquin

et al. 2021

Cancers

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“…The authors showed that NeoRT and AdjRT improved OS and 5-year OS compared to surgery alone [weighted mean difference (WMD): −22.93; 95% CI: −27.91, −17.96; P<0.0001] and (WMD: −18.93; 95% CI: −19.13, −18.74; P<0.0001), comparatively. Median RFS was also significantly increased in patients treated with either surgical resection and NeoRT or surgical resection (WMD: 0.19; 95% CI: 0.11, 0.33; P<0.0001) and AdjRT (WMD: 0.49; 95% CI: 0.32, 0.75; P=0.001) compared to surgery alone (45).…”

Section: Radiotherapy Schedulesmentioning

confidence: 94%

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

et al. 2020

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Retroperitoneal sarcomas (RPSs) are rare diseases, and the 5-year overall survival rate remains low. Management of RPSs is challenging, and the quality of treatment strategy is a crucial prognostic factor.Treatment decisions and the treatment department to which the patients is referred must be centralized.Overall survival rate is positively correlated with the number of patients treated in the centers. En bloc surgery is the standard of care for effective treatment and potential for cure, whereas perioperative chemotherapy or radiotherapy has not yet been validated. Pre-or postoperative radiotherapy was considered controversial, but the STRASS trial publication illustrated that preoperative radiation could be useful in some conditions.Retroperitoneal liposarcoma might become a future target of prospective trials. Furthermore, some retrospective studies have shown that preoperative radiotherapy increases the rate of R0-R1 resections. This article reviews the role of external beam radiotherapy in the management of RPS and highlights the optimal volumes, doses, and radiotherapy techniques for the treatment of RPS. As accurately predicting prognosis in patients with RPS is challenging, we also emphasize the utility of nomograms in the field of radiotherapy.However, these nomograms do not include radiotherapy as a predictive factor. Although some authors could conclude that use of radiotherapy should be avoided based on the results of the STRASS trial, some data argue that radiotherapy still has utility in select cases.

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“…6 Due to the rarity and heterogeneity of RPS, there is a paucity of prospective data to inform the role of RT in a multimodality treatment approach. 73 The recently published preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC 62092: STRASS) trial did not show a statistically significant abdominal recurrence-free survival benefit for the addition of RT to surgical resection. 56 Post hoc exploratory analyses were conducted to evaluate whether specific histopathologic subtypes of RPS were more or less likely to benefit from preoperative RT.…”

Section: What Is the Role For Rt In The Treatment Of Rps And What Are The Preferred Dose Regimens And Treatment Planning Considerations Imentioning

confidence: 97%

Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline

Salerno

Alektiar

Baldini

et al. 2021

Practical Radiation Oncology

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Sources of support: This work was funded by the American Society for Radiation Oncology. Disclosures: All task force members' disclosure statements were reviewed before being invited and were shared with other task force members throughout the guideline's development. Those disclosures are published within this report. Where potential conflicts were detected, remedial measures to address them were taken.

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Perioperative radiotherapy versus surgery alone for retroperitoneal sarcomas: a systematic review and meta-analysis

Cited by 34 publications

References 29 publications

Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells

Senolytic Targeting of Bcl-2 Anti-Apoptotic Family Increases Cell Death in Irradiated Sarcoma Cells

A critical narrative review of radiotherapy for retroperitoneal soft tissue sarcoma

Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline

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