Phase I Trial of Preoperative Concurrent Doxorubicin and Radiation Therapy, Surgical Resection, and Intraoperative Electron-Beam Radiation Therapy for Patients With Localized Retroperitoneal Sarcoma

Pisters, Peter W.T.; Ballo, Matthew T.; Fenstermacher, Mark J.; Feig, Barry W.; Hunt, Kelly K.; Raymond, Kevin; Burgess, Michael A.; Zagars, Gunar K.; Pollock, Raphael E.; Benjamin, Robert S.; Patel, Shreyaskumar

doi:10.1200/jco.2003.01.143

Cited by 141 publications

(64 citation statements)

References 15 publications

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“…In addition, studies often mix up different groups of patients. [17][18][19][20][21][22][23][24][25] Therefore, most guidelines for clinical practice are based on phase 2 studies and historic comparisons. This emphasizes the importance of predictive and prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

The prognostic impact of dedifferentiation in retroperitoneal liposarcoma

Mussi

Collini

Miceli³

et al. 2008

Cancer

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BACKGROUND.A series of patients with well differentiated (WD)/dedifferentiated (DD) retroperitoneal liposarcoma (RLS) was studied to evaluate the prognostic value of the presence, extension, and grade of the DD component.METHODS.Among 148 patients with RLS who underwent surgery over 20 years, the authors retrieved data on patients who had localized WD/DD RLS. For the current analysis, patients were included only if they had primary disease or a first recurrence at their initial presentation. The DD component, when present, was graded according to National Federation of Centers in the Fight Against Cancer (FNCLCC) criteria, and the extension of the DD component was described as a percentage. Univariate and multivariate analyses were carried out for local recurrence‐free survival (LRFS), event‐free survival (EFS), and disease‐specific survival (DSS).RESULTS.Of 93 patients who were identified, 36 patients (39%) had WD RLS, and 57 patients (61%) had DD RLS. The median follow‐up was 71 months (range, 28‐132 months). Seven patients (7.5%) developed distant metastases, including 5 patients who had DD RLS. The 5‐year DSS rate was 42% in patients with DD RLS and 71.6% in patients with WD RLS (P = .018). The corresponding rates for LRFS were 22% and 43.3%, respectively (P = .007). The presence of the DD component and its FNCLCC grade were independent prognostic factors for DSS and LRFS. The administration of radiation therapy was associated independently with better LRFS.CONCLUSIONS.Patients with high‐grade DD RLS had a worse prognosis in terms of both DSS and LRFS. The extension of the DD component and its mitotic index were relevant for EFS. The results indicated that radiation therapy may improve LRFS. These data may help stratify the risk of recurrence for patients with RLS. Clinical studies on new multimodality approaches are warranted. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

The prognostic impact of dedifferentiation in retroperitoneal liposarcoma

Mussi

Collini

Miceli³

et al. 2008

Cancer

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“…There have been several pilot or phase I studies utilizing idoxuridine-or doxorubicin-based chemoradiation [27][28][29].…”

Section: Combined Chemotherapy and Radiation Therapymentioning

confidence: 99%

Retroperitoneal sarcomas: Combined-modality treatment approaches

2006

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Retroperitoneal sarcomas (RPS) are rare tumors, accounting for approximately 15% of soft tissue sarcomas. Surgical resection of localized tumors with gross and microscopically negative margins remains the standard of care. However, because RPS are frequently large and locally advanced, resections are often incomplete, resulting in local recurrence. Investigators are evaluating combined-modality therapies to improve local control and disease-specific survival. This review outlines current concepts and evolving treatment strategies in the diagnosis, staging, and management of RPS.

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“…It has been shown that RT reduces the likelihood of local recurrence, but it has not been shown that RT provides a definite survival benefit. [12][13][14][15][16] A problem asso- ciated with adjuvant RT is that the dose is limited by the tolerance of the surrounding normal tissues, primarily the small bowel, to 45-50 grays (Gy) over 5 weeks. It has been shown that these doses are effective in extremity sarcomas when they are administered preoperatively but are lower than doses traditionally administered postoperatively (60 -65 Gy over 6 -7 weeks).…”

Section: Treatmentmentioning

confidence: 99%

Retroperitoneal soft tissue sarcoma

Mendenhall

Zlotecki

Hochwald

et al. 2005

Cancer

150

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The objective of the current study was to define the optimal treatment for patients with retroperitoneal soft tissue sarcomas (RPS). The authors conducted a review of the pertinent literature and found that the majority of patients had locally advanced RPS at the time of diagnosis. Surgery was the mainstay of treatment, and macroscopic total excision was feasible in approximately 50 -67% of patients. The 5-year probability of local control was approximately 50%, and the likelihood of developing distant metastasis was approximately 20 -30%. The 5-year survival rate was approximately 50%, and deaths due to recurrent RPS continued to occur after 5 years. Postoperative radiotherapy (RT) decreased the likelihood of local recurrence, although it demonstrated no impact on survival. Adjuvant chemotherapy had no proven efficacy. The factor that was found to have the greatest impact on the prognosis for patients with RPS was the ability to achieve a macroscopic total resection. The authors concluded that RPS usually is advanced at the time of diagnosis. The optimal treatment was complete resection. Most patients experienced recurrent disease after surgery, and the most common site of failure was local. Adjuvant RT reduced the risk of local recurrence, but its impact on survival was questionable. Cancer 2005;104:669 -75.

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Phase I Trial of Preoperative Concurrent Doxorubicin and Radiation Therapy, Surgical Resection, and Intraoperative Electron-Beam Radiation Therapy for Patients With Localized Retroperitoneal Sarcoma

Abstract: Preoperative chemoradiation, surgical resection, and EB-IORT are feasible for patients with RPS. Preoperative external-beam radiation can be administered to a total dose of 50.4 Gy with continuous-infusion doxorubicin.

Cited by 141 publications

References 15 publications

The prognostic impact of dedifferentiation in retroperitoneal liposarcoma

The prognostic impact of dedifferentiation in retroperitoneal liposarcoma

Retroperitoneal sarcomas: Combined-modality treatment approaches

Retroperitoneal soft tissue sarcoma

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