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Retroperitoneal soft tissue sarcoma: low-dose neoadjuvant radiation therapy followed by surgery with or without intraoperative radiotherapy and adjuvant radiation therapy

  • Simon KirsteEmail author
  • Nicole Landenberger
  • Jutta Scholber
  • Karl Henne
  • Uwe A. Wittel
  • Anca-Ligia Grosu
Case Study
  • 43 Downloads

Abstract

Background

We describe the clinical history, outcome, and toxicity of five patients with high-grade retroperitoneal soft tissue sarcoma (RSTS) who were treated with neoadjuvant low-dose radiotherapy (RT) followed by resection with or without intraoperative radiotherapy (IORT), followed by adjuvant RT. We aim to provide additional evidence for the various treatment options that exist for this rare tumor entity.

Methods

Most patients presented with mild abdominal symptoms. Diagnosis was confirmed by biopsy. Additional imaging was done by sonography, magnetic resonance imaging (MRI), and/or positron emission tomography (PET)/computed tomography (CT). All patients were treated with neoadjuvant RT of 19.8 Gy in 1.8-Gy fractions followed by resection and postoperative RT up to 45 Gy with a median interval between resection and start of postoperative RT of 5 weeks. Two patients received additional IORT. Median follow-up was 61 months.

Results

One patient developed a local recurrence that was diagnosed 30 months after the start of the first therapy. He was treated with a salvage resection and had no evidence of disease at the last follow-up. Another patient developed a right-sided RSTS on the contralateral side from the primary radiation field with pelvic bone infiltration 56 months after the start of RT. He was treated again by RT and resection and was without evidence of disease at last follow-up. Radiotherapy was well tolerated without major toxicity.

Conclusion

The treatment of RSTS by low-dose neoadjuvant RT, resection with IORT and adjuvant RT seems to be a feasible and effective treatment approach. Further studies comparing neoadjuvant with adjuvant RT are necessary to find the best treatment option.

Keywords

High-grade sarcoma Intraoperative radiotherapy Wound complications Resection Adjuvant treatment 

Retroperitoneales Weichteilsarkom: Niedrigdosierte neoadjuvante Strahlentherapie gefolgt von Resektion mit und ohne intraoperative Strahlentherapie und adjuvanter Strahlentherapie

Zusammenfassung

Hintergrund

Die vorliegende Studie beschreibt den klinischen Verlauf, die Ergebnisse und Nebenwirkungen bei fünf Patienten mit retroperitonealen „High-grade“-Weichteilsarkomen (RSTS), die mit einer neoadjuvanten Niedrigdosis-Strahlentherapie (RT) gefolgt von Resektion mit oder ohne intraoperativer Strahlentherapie (IORT) und einer adjuvanten Strahlentherapie behandelt wurden.

Methoden

Die meisten Patienten stellten sich mit leichten abdominellen Symptomen vor. Die Diagnose wurde durch eine Biopsie gestellt. Bildgebung wurde mittels Sonographie, Magnetresonanztomographie (MRT) und/oder Positronenemissionstomographie (PET)/Computertomographie (CT) durchgeführt. Alle Patienten wurden mit einer neoadjuvanten RT von 19,8 Gy in Fraktionen mit 1,8 Gy gefolgt von der Resektion und postoperativen RT mit 45 Gy behandelt. Das mittlere Intervall zwischen Resektion und postoperativer RT betrug 5 Wochen. Zwei Patienten erhielten eine zusätzliche IORT. Die mediane Nachbeobachtungszeit betrug 61 Monate.

Ergebnisse

Bei einem Patienten kam es zum Auftreten eines Lokalrezidivs 30 Monate nach Therapiebeginn. Das Rezidiv wurde mit einer Resektion behandelt. Bei der letzten Nachsorgeuntersuchung gab es keine Anzeichen eines Rezidivs. Bei einem anderen Patienten trat ein kontralaterales Sarkom mit Knocheninfiltration 56 Monate nach Therapiebeginn auf. Es wurden eine erneute RT und Resektion durchgeführt. Bei der letzten Nachuntersuchung gab es keine Hinweise auf ein Rezidiv. Die Bestrahlung wurde insgesamt sehr gut vertragen.

Schlussfolgerung

Die Therapie von RSTS mit neoadjuvanter Niedrigdosis-RT, Resektion mit IORT und adjuvanter RT ist eine gut verträgliche und effektive Behandlungsoption. Weitere Studien, die eine neoadjuvante mit einer adjuvanten RT vergleichen, sind notwendig.

Schlüsselwörter

High-grade Sarkom Intraoperative Strahlentherapie Wundkomplikationen Resektion Adjuvante Therapie 

Notes

Conflict of interest

S. Kirste, N. Landenberger, J. Scholber, K. Henne, U.A. Wittel, and A.-L. Grosu declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyUniversity Medical Center FreiburgFreiburgGermany
  2. 2.Department of General and Visceral SurgeryUniversity Medical Center FreiburgFreiburgGermany
  3. 3.Partner Site Freiburg (DKTK)German Cancer ConsortiumFreiburgGermany

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