A. Porpiglia1, j. M. Farma1, M. Von Mehren1, S. Movva1, P. R. Anderson1, A. S. Patchefsky1, S. Reddy1 1Fox Chase Cancer Center,Surgical Oncology,Philadelphia, PA, USA
Introduction: Retroperitoneal sarcomas account for 15% of all soft tissue sarcomas and they have a worse prognosis than extremity soft tissue sarcomas. The reason for this is multifactorial, including delay in diagnosis, surgically unresectable disease, and high recurrence rates. Recurrence rates for retroperitoneal sarcomas have been reported as high as 70%. Complete surgical resection is the most important prognostic factor for prolonged survival. Radiation therapy has been utilized to help achieve negative surgical margins and to potentially decrease rates of local recurrence. The study was to review the experience at a tertiary referral center specializing in the multidisciplinary care of treating patients with retroperitoneal sarcomas. The goal of the study was to determine if there was a difference in local recurrence rates or postoperative morbidity for patients treated with preoperative radiation therapy and surgery or for those treated with surgery alone.
Methods: Retrospective review of patients treated for retroperitoneal sarcomas at Fox Chase Cancer Center from 1997-2015, with IRB approval. Chi-square and Student t-tests were used to assess primary endpoints of recurrence and postoperative morbidity.
Results: There were 73 patients identified with retroperitoneal sarcomas treated with preoperative radiation therapy and surgery (18patients) or surgery alone (55 patients). The median age was 60 years and there were more females than males, 55% versus 45% respectively. The predominant histologies were: liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Sixty-eight percent of patients had tumors greater than 10cm. There were more low-grade tumors in the surgery alone group and there were more high-grade tumors in the XRT/surgery group. However this was not statistically significant, p=0.17. Fifty-one percent of the patients developed recurrence. The surgery alone group had more local recurrences compared to the surgery/XRT group (36% versus 17%, p=0.014). Complication rate for the entire group was 35.6%. However, there was no difference in postoperative morbidity between the two groups.
Conclusion: The mainstay of treatment of patients with retroperitoneal sarcomas is surgery. However, with the high rates of local recurrence rates, the large size of the tumors, and involvement of adjacent organs radiation therapy is a viable adjunct to surgery. Our study demonstrated improved local recurrence rates with radiation therapy with no increase in morbidity.
