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A Contemporary Large Single-Institution Evaluation of Resected Retroperitoneal Sarcoma

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Retroperitoneal sarcomas (RPS) are rare malignancies, comprising just 10–15 % of all soft-tissue sarcomas. These are challenging tumors to treat, with surgical resection being the only modality capable of providing a cure. This study analyzed the management and survival of patients resected at a large academic institution.

Methods

A retrospective study of all patients with primary localized RPS referred to the University of Washington between January 2000 and January 2013 was performed. Univariate and multivariate Cox regression models were used to analyze progression-free survival (PFS) and overall survival (OS) by patient, tumor, and treatment variables.

Results

The study identified 132 patients. Median follow-up was 31.8 months. Median PFS was 33 months, and median OS was 111 months. Sixty patients (45.5 %) underwent a margin-negative resection (R0), 59 (44.7 %) had a microscopic margin-positive resection (R1), and 7 (5.3 %) had a macroscopic margin-positive resection (R2). Forty (30.3 %) patients received preoperative radiation, 28 (21.2 %) received neoadjuvant chemotherapy, and 7 (5.3 %) received both. Tumor grade and microscopic margin status emerged as statistically significant predictors for both PFS and OS. Tumor size was also found to correlate with PFS. No significant difference in OS or PFS was observed for histologic subtype, neoadjuvant chemotherapy, or neoadjuvant radiation.

Conclusions

Complete surgical resection should remain the mainstay of management for RPS, with emphasis on achieving negative microscopic margins. Neither neoadjuvant chemotherapy nor radiation was shown to significantly improve survival, and their unclear role in the management of RPS requires evaluation in a prospective setting.

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References

  1. Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94:81–7.

    Article  PubMed  Google Scholar 

  2. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355–65.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27:31–7.

    Article  PubMed  Google Scholar 

  4. Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27:24–30.

    Article  PubMed  Google Scholar 

  5. Pisters PW. Resection of some: but not all—clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcomas. J Clin Oncol. 2009;27:6–8.

    Article  PubMed  Google Scholar 

  6. Strauss DC, Hayes AJ, Thway K, et al. Surgical management of primary retroperitoneal sarcoma. Br J Surg. 2010;97:698–706.

    Article  CAS  PubMed  Google Scholar 

  7. Youssef E, Fontanesi J, Mott M, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys. 2002;54:514–9.

    Article  PubMed  Google Scholar 

  8. Jaques D, Coit D, Hajdu S, et al. Management of primary and recurrent soft tissue sarcoma. Ann Surg. 1990;212:51–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Tepper JE, Suit HD, Wood WC, et al. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1984;10:825–30.

    Article  CAS  PubMed  Google Scholar 

  10. Karakousis CP, Gerstenbluth R, Kontzoglou K, Driscoll DL. Retroperitoneal sarcomas and their management. Arch Surg. 1995;130:1104–9.

    Article  CAS  PubMed  Google Scholar 

  11. Pirayesh A, Chee Y, Helliwell TR, et al. The management of retroperitoneal soft tissue sarcoma: a single institution experience with a review of the literature. Eur J Surg Oncol. 2001;27:491–7.

    Article  CAS  PubMed  Google Scholar 

  12. Fein DA, Corn BW, Lanciano RM, Herbert SH, Hoffman JP, Coia LR. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control? Int J Radiat Oncol Biol Phys. 1995;31:129–34.

    Article  CAS  PubMed  Google Scholar 

  13. Gilbeau L, Kantor G, Stoeckle E, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol. 2002;65:137–43.

    Article  PubMed  Google Scholar 

  14. Patrikidou A, Domont J, Cioffi A, Le Cesne A. Treating soft tissue sarcomas with adjuvant chemotherapy. Curr Treat Options Oncol. 2011;12:21–31.

    Article  PubMed  Google Scholar 

  15. Strauss DC, Hayes AJ, Thomas JM. Retroperitoneal tumours: review of management. Ann R Coll Surg Engl. 2011;93:275–80.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  17. Anaya DA, Lev DC, Pollock RE. The role of surgical margin status in retroperitoneal sarcoma. J Surg Oncol. 2008;98:607–10.

    Article  PubMed  Google Scholar 

  18. Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol. 2013;31:1649–55.

    Article  PubMed  Google Scholar 

  19. Anaya DA, Lahat G, Wang X, et al. Postoperative nomogram for survival of patients with retroperitoneal sarcoma treated with curative intent. Ann Oncol. 2010;21:397–402.

    Article  CAS  PubMed  Google Scholar 

  20. Ardoino I, Miceli R, Berselli M, et al. Histology-specific nomogram for primary retroperitoneal soft tissue sarcoma. Cancer. 2010;116:2429–36.

    PubMed  Google Scholar 

  21. Gronchi A, Miceli R, Colombo C, et al. Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol. 2012;23:1067–73.

    Article  CAS  PubMed  Google Scholar 

  22. Singer S, Corson JM, Demetri GD, Healey EA, Marcus K, Eberlein TJ. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995;221:185–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Brown RE, St. Hill CR, Greene QJ, et al. Impact of histology on survival in retroperitoneal sarcomas. Am J Surg. 2011;202:748–52; (discussion 752–3).

    Article  PubMed  Google Scholar 

  24. Mazanet R, Antman KH. Adjuvant therapy for sarcomas. Semin Oncol. 1991;18:603–12.

    CAS  PubMed  Google Scholar 

  25. Robertson JM, Sondak VK, Weiss SA, Sussman JJ, Chang AE, Lawrence TS. Preoperative radiation therapy and iododeoxyuridine for large retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys. 1995;31:87–92.

    Article  CAS  PubMed  Google Scholar 

  26. Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol. 2003;21:3092–7.

    Article  CAS  PubMed  Google Scholar 

  27. Müller CR, Paulsen EB, Noordhuis P, Pedeutour F, Saeter G, Myklebost O. Potential for treatment of liposarcomas with the MDM2 antagonist Nutlin-3A. Int J Cancer. 2007;121:199–205.

    Article  PubMed  Google Scholar 

  28. Jones RL, Fisher C, Al-Muderis O, Judson IR. Differential sensitivity of liposarcoma subtypes to chemotherapy. Eur J Cancer. 2005;41:2853–60.

    Article  CAS  PubMed  Google Scholar 

  29. Feng M, Murphy J, Griffith KA, et al. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69:103–10.

    Article  PubMed  Google Scholar 

  30. European Organisation for Research and Treatment of Cancer—EORTC (2012). A phase III randomized study of preoperative radiotherapy plus surgery versus surgery alone for patients with Retroperitoneal sarcomas (RPS): STRASS. http://www.eortc.be/clinicaltrials/details.asp?protocol=62092. Accessed April 20 2013.

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Acknowledgment

The authors acknowledge our colleagues in the Sarcoma Unit as well as the Departments of Surgery, Radiation Oncology, Anatomic Pathology, and Biostatistics for their contributions to this study. This study was supported by the Bob and Eileen Gilman Family Sarcoma Research Fund.

Disclosures

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. School of Medicine, University of Washington, Seattle, WA, USA

    Prashoban J. Bremjit BS

  2. Department of Medical Oncology, University of Washington, Seattle, WA, USA

    Robin L. Jones MD, MRCP, Eve T. Rodler MD, Elizabeth T. Loggers MD, PhD & Seth M. Pollack MD

  3. Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109-1023, USA

    Robin L. Jones MD, MRCP, Eve T. Rodler MD, Elizabeth T. Loggers MD, PhD & Seth M. Pollack MD

  4. Department of Clinical Statistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Xiaoyu Chai MS

  5. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Gabrielle Kane MB, EdD, FRCPC

  6. Group Health Research Institute, Seattle, WA, USA

    Elizabeth T. Loggers MD, PhD

  7. Department of Surgical Oncology, University of Washington, Seattle, WA, USA

    Venu G. Pillarisetty MD & Gary N. Mann MD, BCh

Authors
  1. Prashoban J. Bremjit BS
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  2. Robin L. Jones MD, MRCP
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  3. Xiaoyu Chai MS
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  4. Gabrielle Kane MB, EdD, FRCPC
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  5. Eve T. Rodler MD
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  6. Elizabeth T. Loggers MD, PhD
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  7. Seth M. Pollack MD
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  8. Venu G. Pillarisetty MD
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  9. Gary N. Mann MD, BCh
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Corresponding author

Correspondence to Robin L. Jones MD, MRCP.

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Bremjit, P.J., Jones, R.L., Chai, X. et al. A Contemporary Large Single-Institution Evaluation of Resected Retroperitoneal Sarcoma. Ann Surg Oncol 21, 2150–2158 (2014). https://doi.org/10.1245/s10434-014-3616-7

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  • DOI: https://doi.org/10.1245/s10434-014-3616-7

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