Opinion statement
The approach to the management of retroperitoneal tumors begins with a complete history and physical examination. Imaging of the abdomen and pelvis by computed tomography (CT) provides both an imaging modality and a method by which to obtain tissue for diagnosis. Because a histologic diagnosis is essential in treatment planning, adequate tissue can usually be obtained by a CT-guided core biopsy. If the diagnosis is sarcoma, additional tests necessary for staging include plain chest radiography and evaluation of the liver by either CT scan or magnetic resonance imaging (MRI). The treatment options for primary retroperitoneal sarcomas include chemotherapy, radiation therapy, surgery, or a combination of these modalities; therefore, a multidisciplinary group best manages treatment planning. Primary radiation therapy for cure is seldom effective for retroperitoneal sarcomas but can provide palliation in select cases. Systemic chemotherapy for chemosensitive lesions, such as poorly differentiated liposarcoma, malignant fibrous histiocytoma (MFH), synovial cell sarcoma, and primitive neuroectodermal tumors (PNET), can be useful when used in a neoadjuvant manner. Consequently, surgical resection continues to be the mainstay of treatment for retroperitoneal sarcomas and requires en bloc resection of the primary tumor. Frequently this includes adjacent organs such as colon, small bowel, kidney, adrenal, and pancreas. Postoperative adjuvant therapy with chemotherapy or radiation has not been proven to be of any additional benefit. Overall treatment results are predominantly influenced by tumor stage, grade, size, and margins of surgical resection. Follow-up CT scans at 6-month intervals and surgical resection of recurrences can be valuable.
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References and Recommended Reading
Storm FK, Mahvi DM: Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg 1991, 214:2–10.
Singer S, Eberlein TJ: Surgical management of softtissue sarcoma. Adv Surg 1997, 31:395–420.
Sindelar W, Kinsella T, Chen P, et al.: Intraoperative radiotherapy I retroperitoneal sarcoma: final results of a prospective randomized clinical trial. Arch Surg 1993, 128:402–410.
Arlen M, Marcove RC: Retroperitoneal sarcomas. In Surgical Management of Soft Tissue Sarcomas. Philadelphia: WB Saunders; 1987:220.
Heslin MJ, Lewis JJ, Nadler E, et al.: Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997, 15:2832–2839.
Lewis JJ, Leung D, Woodruff JM, Brennan MF: Retroperitoneal soft-tissue sarcoma. Ann Surg 1998, 228:355–365. Largest series of retroperitoneal sarcomas. Excellent analysis of prognostic factors.
Bevilacqua RG, Rogatko A, Hajdu SI, Brennan MF: Prognostic factors in primary retroperitoneal softtissue sarcomas. Arch Surg 1991, 126:328–334.
Singer S, Corson JM, Demetri GD, et al.: Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg 1995, 221:185–195.
Kilkenny JW, Bland KI, Copeland EM: Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg 1996, 182:329–339.
Alvarenga JC, Ball AB, Fisher C, et al.: Limitations of surgery in the treatment of retroperitoneal sarcoma. Br J Surg 1991, 78:912–916.
Rosen G, Forscher C, Lowenbraun S, Eilber F, et al.: Synovial sarcoma. Uniform response of metastases to high dose ifosfamide. Cancer 1994, 73:2506–2511.
Le Cesne A, Antoine E, Spielmann M, et al.: High-dose ifosfamide: circumvention of resistance to standarddose ifosfamide in advanced soft tissue sarcomas. J Clin Oncol 1995, 13:1600–1608.
Eilber FR, Eckardt J: Surgical management of soft tissue sarcomas. Semin Oncol 1997, 24:526–533.
Haskell CM. Cancer Treatment, edn 4. WB Saunders; 1995:108-110, 123-125.
O’Bryan RM, Baker LH, Gottlieb JE, et al.: Dose response evaluation of adriamycin in human neoplasia. Cancer 1977, 39:1940–1948.
Legha SS, Benjamin RS, Mackay B, et al.: Reduction of doxorubicin cardiotoxicity by prolonged continuous intravenous infusion. Ann Intern Med 1982, 96:133–139.
Elias AD, Eder JP, Shea T, et al.: High-dose ifosfamide with mesna uroprotection: a phase I study. J Clin Oncol 1990, 8:170–178.
Catton CN, O’Sullivan B, Kotwall C, et al.: Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994, 29:1005–1010.
Clark JA, Tepper JE: Role of radiation therapy in retroperitoneal sarcomas. Oncology 1996, 10:1867–1874.
Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR: Leiomyosarcoma of the inferior vena cava. Prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer 1999, 85:1077–1083. This is an important study of the unique biology of a rare retroperitoneal sarcoma.
Herman K, Kusy T: Retroperitoneal sarcoma-the continued challenge for surgery and oncology. Surg Oncol 1998, 7:77–81.
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Eilber, F.C., Eilber, K.S. & Eilber, F.R. Retroperitoneal sarcomas. Curr. Treat. Options in Oncol. 1, 274–278 (2000). https://doi.org/10.1007/s11864-000-0040-y
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DOI: https://doi.org/10.1007/s11864-000-0040-y