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The Role of Radiation in Retroperitoneal Sarcomas

  • Sarcoma (SH Okuno, Section Editor)
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Opinion statement

Retroperitoneal sarcomas form a group of rare malignancies that require expertise in every aspect of management. Patients benefit from referral to cancer centers that can provide comprehensive, multidisciplinary, oncologic management. The role of radiation in retroperitoneal sarcoma management is, appropriately, the subject of considerable controversy due to the absence of high-level evidence proving its efficacy. Nonetheless, the preponderance of available data suggests that radiation therapy likely improves local control and, in some settings, may favorably impact resectability and survival. These outcome observations coupled with the lower doses (45–54 Gy) and normal tissue displacement characteristic of preoperative radiation therapy leads us to favor preoperative radiotherapy followed by oncologic resection for most retroperitoneal sarcomas. This strategy appears to provide the highest chance of safe and successful delivery of multimodal therapy, which can otherwise be hindered by postoperative complications as a result of technically challenging surgery and normal tissue radiation dose tolerances. Dose-escalation and selective integrative boosts to “at-risk” margins are attractive strategies that merit, and arguably require, further clinical evaluation. We believe that postoperative radiotherapy should be reserved for very high-risk cases and should be treated to a dose of ≥60 Gy respecting normal tissue dose tolerances. An additional approach that we consider in the postoperative setting is close surveillance with consideration of preoperative radiotherapy at recurrence before repeat surgical resection. Highly conformal radiotherapy techniques, such as IMRT with image guidance, should be employed to minimize dose to normal tissues and thereby allow delivery of efficacious radiation doses. If feasible, referral to a treatment facility with proton beam therapy should be discussed with the patient, especially if normal tissue dose constraints cannot be met using IMRT/IGRT. Participation in prospective studies should be highly encouraged.

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Conflicts of Interest

Pranshu Mohindra declares that he has no conflict of interest.

Heather B. Neuman declares that she has no conflict of interest.

Kevin R. Kozak declares that he has no conflict of interest.

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Authors and Affiliations

  1. Department of Human Oncology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, K4/B100, Madison, WI, 53792, USA

    Pranshu Mohindra MD, Pranshu Mohindra MD & Kevin R. Kozak MD, PhD

  2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, K4/B100, Madison, WI, 53792, USA

    Heather B. Neuman MD

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  1. Pranshu Mohindra MD
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Correspondence to Pranshu Mohindra MD or Kevin R. Kozak MD, PhD.

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Mohindra, P., Neuman, H.B. & Kozak, K.R. The Role of Radiation in Retroperitoneal Sarcomas. Curr. Treat. Options in Oncol. 14, 425–441 (2013). https://doi.org/10.1007/s11864-013-0236-6

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