title: Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma.
abstract: BACKGROUND
  Surgical resection alone does not cure the majority of patients with retroperitoneal sarcoma (RPS). We evaluated the effects of preoperative external-beam radiotherapy (XRT) and postoperative brachytherapy (BT) combined with complete surgical resection.
  
  
  METHODS
  Fifty-five patients with primary or locally recurrent RPS judged to be resectable were entered onto a trial of combined therapy and observed prospectively. Forty-six patients underwent complete gross resection with curative intent. Of these, 41 patients completed preoperative XRT and 23 patients received BT. Outcome measures were treatment toxicity, overall survival, and disease-free survival (DFS).
  
  
  RESULTS
  Preoperative XRT was very well tolerated and was associated with Radiation Therapy Oncology Group acute toxicity scores of < or = 2 in all patients. Acute postoperative and BT-related toxicity resulted in modified RTOG scores of > or = 3 in 39.1% (18 of 46) of patients. Late toxicity was associated with death in 4.3% (2 of 46) and with life-threatening illness in 2.2% (1 of 46) of patients, all of whom had been treated with BT to the upper abdomen. The 2-year overall survival and DFS for resected RPS were 88% and 80%, respectively. Significantly better 2-year DFS was achieved in patients with primary RPS and in those with low-grade tumors (93% and 95%, respectively).
  
  
  CONCLUSIONS
  The initial results of combined therapy are promising. Although preoperative XRT was very well tolerated, BT to the upper abdomen was associated with substantial toxicity. Our current protocol includes selective application of BT to the lower abdomen only.
authors: University of Toronto Sarcoma Group, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Julia J
authors: JJ
authors: Jones
authors: Charles N
authors: CN
authors: Catton
authors: Brian
authors: B
authors: O'Sullivan
authors: Jean
authors: J
authors: Couture
authors: Ryan L
authors: RL
authors: Heisler
authors: Rita A
authors: RA
authors: Kandel
authors: Carol J
authors: CJ
authors: Swallow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D004583:Electrons; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome