Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience.
BACKGROUND
In the management of retroperitoneal sarcomas it is necessary to achieve local control to ensure survival. The role of adjuvant radiation therapy (RT), either pre- or postoperative, remains controversial.


METHODS
Outcomes for 40 patients with retroperitoneal sarcoma treated with surgery and postoperative RT (n = 25) or preoperative RT (n = 15) were analyzed for variables prognostic for local control, survival, and associated complications.


RESULTS
Patterns of failure for patients treated by resection and postoperative RT were local (n = 4), local and distant (n = 3), and distant (n = 3). The failure patterns for preoperative RT cases were local (n = 2), local and distant (n = 2); and distant (n = 4). Median time to local recurrence in the postoperative and preoperative RT series were 1 year and 2.5 years respectively. The margin status was predictive for local control (P = 0.0065) and survival (P = 0.0012), regardless of treatment sequence. Absolute 5-year survival was 12% with positive margins versus 69% if negative. Histologic grade was indicative of the risk for distant metastasis (low grade 8% vs high grade 64%; P = 0.1373), and significantly predicted 5-year absolute survival (low grade 77% vs high grade 34%; P = 0.0267). Postoperative RT was associated with significant complications (infection, hemorrhage, and bowel obstruction--2 cases each).


CONCLUSIONS
Compared with the surgery-alone series, adjuvant RT appears to improve the probability of local control. Preoperative RT may be the preferred sequence potentially to improve tumor resectability and local-regional control with less risk of complications than with postoperative RT.
Zlotecki
Robert A
RA
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA. zlotera@ufl.edu
Katz
Teri S
TS
Morris
Christopher G
CG
Lind
D Scott
DS
Hochwald
Steven N
SN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005431:Florida; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D007496:Iridium Radioisotopes