Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

Dziewirski, Wirginiusz; Rutkowski, Piotr; Nowecki, Zbigniew; Sałamacha, Maciej; Morysiński, Tadeusz; Kulik, Anna; Kawczyńska, Maria; Kasprowicz, Anetta; Łyczek, Jarosław; Ruka, W.

doi:10.1245/aso.2006.03.026

Cited by 57 publications

(38 citation statements)

References 40 publications

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“…Patients who received the combination of HDR-IORT and EBRT had a significant improvement in local recurrence-free survival compared with patients who received HDR-IORT alone. 50,51 Toxicity IOERT IOERT induces severe complications in up to 37% of patients; and neuropathy, hydronephrosis, gastrointestinal fistula, small bowel obstruction, and vaginal and ureteroarterial fistula are the most frequent. 17,45,49 To limit the risk of grade 3 neuropathy, the RT dose should kept below 15 Gy.…”

Section: Hdr-iortmentioning

confidence: 99%

“…10,47,50,51 Ballo et al did not use Radiation Therapy Oncology Group criteria for toxicity, but all 5 of their patients (10% at 5 years) who developed RT-related complications had received postoperative EBRT. 47 Preoperative RT Alone or in Combination With Other Forms of RT There are several theoretical advantages for preoperative RT compared with postoperative RT.…”

Section: Hdr-iortmentioning

confidence: 99%

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Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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The authors undertook a systematic review to designate the role that radiotherapy (RT) might play in the treatment of retroperitoneal sarcomas. Correlating with recent literature, the objective of this review was to evaluate whether there was enough evidence for the authors to develop an institutional treatment protocol concerning the use of RT in the treatment of retroperitoneal sarcoma. Furthermore, this was a call for surgeons to talk to radiation oncologists before performing surgery. The 2 objectives of this review were: 1) to determine the benefit of RT in terms of local control and/or survival in the treatment of retroperitoneal sarcomas and 2) to discover the optimal timing of RT in the treatment sequence. A computerized literature search was performed in the PubMed database, the Cochrane Library database, and reference lists; and journals also were searched by hand to identify all retrospective and prospective reports published since 1998 relating to RT treatment of adult retroperitoneal sarcoma. Mainly, analyses were sought that were based on a 5-year local control rate (LCR), 5-year disease-free survival, and 5-year overall survival (OS). If only 2 years follow-up were available, then the authors also noted this outcome. Toxicity data were collected and analyzed separately. The synthesis of the literature was based on 9 prospectively nonrandomized studies and 10 retrospective studies that, together, reviewed a total of 1426 patients. The 5-year LCR varied from 27% to 62%, and the results from other reports fell in between those values. The 5-year OS rate ranged from 12% to 90%, and complete resection and tumor grade were the most important prognostic factors in most studies. This review resulted in 7 recommendations concerning the use of RT in the treatment of retroperitoneal sarcoma. The authors concluded that there is good evidence from multiple single-institutions studies that RT improves the LCR in patients with retroperitoneal sarcoma. Until now, there has not been a translation of this approach into survival benefit. The current results indicated that preoperative external-beam RT followed by radical surgery seems to be the preferred sequence, and adding intraoperative RT is a safe procedure for dose escalation in the upper abdomen. Cancer 2011;117:4355-

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Section: Hdr-iortmentioning

confidence: 99%

Section: Hdr-iortmentioning

confidence: 99%

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Voorde

Delrue

Eijkeren

et al. 2011

Cancer

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“…The abdominal organs are positioned out of the radiation field. It also has the advantage of delivering radiation to specific areas, which carry a high risk of recurrence [36][37][38][39]. IORT is usually combined with preoperative or postoperative radiotherapy.…”

Section: Radiotherapymentioning

confidence: 99%

“…IORT is usually combined with preoperative or postoperative radiotherapy. Few retrospective studies and a prospective trial have reported favourable outcomes with IORT [20,[37][38][39], whereas a study from MD Anderson Cancer Centre (MDACC) has not found any benefit from IORT [27]. IORT is also associated with a significant amount of toxicity.…”

Section: Radiotherapymentioning

confidence: 99%

Retroperitoneal Sarcomas- A Challenging Problem

Kumar

Misra

Chaturvedi

2012

Indian J Surg Oncol

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Retroperitoneal sarcomas are relatively rare tumours and usually present in a locally advanced stage. Liposarcoma is the most common histopathology. If operable, surgery is the treatment of choice. The role of adjuvant chemotherapy or radiotherapy is not yet defined. Advanced cases are treated by chemotherapy. The prognosis is poor in patients with positive resection margins, high-grade tumours and recurrent tumours.

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“…Promising results have been published regarding the use of intraoperative brachytherapy and intraoperative teleradiotherapy following radical excision of the sarcoma, usually in combination with perioperative teleradiotherapy (7,14,(16)(17)(18)(19)(20).…”

mentioning

confidence: 99%

Value of Combined Treatment of Retroperitoneal Sarcomas

Kamiński

Kołosza

Strojek

et al. 2007

Polish Journal of Surgery

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The aim of the study was to determine treatment results in patients with retroperitoneal sarcomas, especially as respects the value of combined therapy. Material and methods. The study group included 37 patients with retroperitoneal sarcomas who underwent treatment at the Department of Oncological Surgery, Oncology Center in Gliwice during the period between 1992 and 2005. The study group included 25 women and 12 men, aged between 21 and 68 years (mean age -56.2 years). Adjuvant therapy after the operation was performed in the case of 15 patients. Nine received adjuvant teleradiotherapy (RT) at an average dose of 47.5 Gy (one patient after a non-resective procedure). Four received intraoperative brachytherapy (BT) at a dose of 15.8 Gy in combination with postoperative teleradiotherapy at a dose of 39 Gy. One patient was subjected to intraoperative brachytherapy. One female patient received adjuvant chemotherapy (Iphosphamid + Adriamycin). Results. The cumulative five-year total survival period of the analysed group was 40.7% according to Kaplan-Meier's method. Twenty patients died and four were diagnosed with recurrence, while 13 continue to live without recurrence. The type of resection had a significant effect on total survival (p=0.013): the five-year survival after radical procedures was 52.1%. We observed no five-year survivals after nonradical procedures. In order to determine the efficacy of combined treatment, patients who underwent to radical therapy were divided into three groups: patients without adjuvant therapy (group 1: 22 patients, 62.9%), patients subjected to adjuvant RT and BT therapy after the primary operation (group II: 5 patients, 14.25%), and patients who underwent the above-mentioned treatments after surgery, due to recurrence (group III: 8 patients, 22.85%). The total five-year survival in group I was 34.8%, in group II, 80%, and in group III, 72.9%. These differences were statistically insignificant (p=0.440). These results were probably influenced by the small number of patients, considering particular groups. Conclusions. 1. The most important prognostic factor in the treatment of retroperitoneal sarcomas is surgical margine type surgical margin. 2. Adjuvant radiotherapy, especially in combination with intraoperative brachytherapy, seems to be a promising method for the management of retroperitoneal sarcomas, and improves treatment results. 3. Treatment of retroperitoneal sarcomas should be undertaken in specialized centers adequately prepared for combined therapy. Key words: retroperitoneal sarcomas, adjuvant radiotherapy, intraoperative brachytherapy, combined therapy of neoplasms POLSKI PRZEGLĄD CHIRURGICZNY 10.2478/v10035-007-0045-3 2007 Retroperitoneal sarcomas are rarely diagnosed and account for only 10-15% of all soft tissue sarcomas, which in turn constitute 1% of all malignant neoplasms. They most often develop after the age of 50 years, and occur with similar frequency in men and women. Based

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Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

Cited by 57 publications

References 40 publications

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Radiotherapy and surgery—An indispensable duo in the treatment of retroperitoneal sarcoma

Retroperitoneal Sarcomas- A Challenging Problem

Value of Combined Treatment of Retroperitoneal Sarcomas

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