Value of Combined Treatment of Retroperitoneal Sarcomas

Abstract

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