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Role of Radiation Therapy for Newly Diagnosed Retroperitoneal Sarcoma

  • Sarcoma (SH Okuno, Section Editor)
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Opinion statement

Soft tissue sarcomas (STS) are rare, aggressive, and heterogenous tumors, comprising approximately 1% of adult cancers with over 50 different subtypes. The mainstay of treatment for retroperitoneal sarcomas (RPS) includes surgical resection. The addition of radiation therapy (RT), either preoperatively or postoperatively, has been used to potentially decrease the risk of local recurrence. The recently published results from STRASS (EORTC-STBSG 62092-22092), which randomized patients to receive or not receive preoperative radiation, indicate no abdominal recurrence-free survival benefit (primary endpoint) nor overall survival benefit to date from the addition of preoperative RT prior to surgical resection in patients with RPS. Keeping in mind caveats of subgroup analyses, the data show a significant reduction in local recurrence with radiation therapy in resected patients and non-significant trends toward improved abdominal recurrence-free survival in all patients and improved local control and abdominal recurrence-free survival in patients with liposarcoma and low-grade sarcoma. Given the high rate of local failure with surgery alone, it is possible that higher RT dose and/or selective RT dose painting may improve outcomes. Prior to treatment, the authors encourage multidisciplinary review and discussion of management options at a sarcoma center for patients with RPS. Selective use of RT may be considered for patients at high risk of local recurrence.

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Authors and Affiliations

  1. Department of Radiation Oncology, Brigham and Women’s Hospital/Dana Farber Cancer Institute, Boston, MA, USA

    Miranda B. Lam MD MBA & Elizabeth H. Baldini MD, MPH

  2. Center for Sarcoma and Bone Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, USA

    Miranda B. Lam MD MBA & Elizabeth H. Baldini MD, MPH

  3. Harvard Medical School, Boston, MA, USA

    Miranda B. Lam MD MBA, Elizabeth H. Baldini MD, MPH & Thomas F. DeLaney MD

  4. Sarcoma Research and Treatment Unit, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Sophie J. M. Reijers MD

  5. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Rick L. Haas MD PhD

  6. Leiden University Medical Centre, Leiden, The Netherlands

    Rick L. Haas MD PhD

  7. Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Thomas F. DeLaney MD

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Elizabeth H. Baldini has received royalty from UpToDate. Thomas F. DeLaney is a member of the Medical Advisory Board Chordoma Foundation, and has received honoraria from Elsevier, Oakstone Medical Publishing, and Best Docs and royalties from UpToDate and Wolters Kluwer Health. Miranda B. Lam declares that she has no conflict of interest. Sophie J.M. Reijers declares that she has no conflict of interest. Rick L. Haas declares that he has no conflict of interest.

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Lam, M.B., Baldini, E.H., Reijers, S.J.M. et al. Role of Radiation Therapy for Newly Diagnosed Retroperitoneal Sarcoma. Curr. Treat. Options in Oncol. 22, 75 (2021). https://doi.org/10.1007/s11864-021-00877-6

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