Use of tissue expanders and pre-operative external beam radiotherapy in the treatment of retroperitoneal sarcoma.
BACKGROUND
We report our experience of treating retroperitoneal sarcoma (RPS) using pre-operative external beam radiotherapy (EBRT) in combination with radical resectional surgery from 1990 to 2005.


METHODS
Twenty-eight primary and 10 recurrent tumors were identified from a prospective database.


RESULTS
The resection rate was 71% overall; 82% in primary (23/28) and 40% (4/10) in recurrent cases. EBRT was administered preoperatively in 25 patients, postoperatively in 1, and palliatively in 11. In 33 patients a saline-filled tissue expander was inserted into the abdomen before radiotherapy to displace small bowel from the radiation field. 4,500-5,000 cGy was administered in fractions of 180-200 cGy over a 5-week period; surgery followed 6-8 weeks later. Expander insertion was associated with minimal morbidity; 31/37 patients received a dose of 4,000 cGy or more (median 4,650 cGy). Median resected tumor diameter was 13 cm, and a median of three adjacent organs was resected per patient. Complete macroscopic resection was achieved in 25/27 patients (93%); R0 in 9 (33%) and R1 in 13 (48%) (microscopic margins unclear in 5). There was no postoperative mortality. Tumors were high-grade in 20 patients, low-grade in 14 and ungraded in 4. Actuarial 5- and 10-year survival for all patients was 74 and 60%. For operable primary tumors, the 5-year survival and disease-free rates were 90 and 80%. In four patients with operable recurrent tumors, median disease-free interval was 91 months (27-160). In the 11 inoperable cases, median survival after radiotherapy was 48 months (9-77).


CONCLUSIONS
We conclude that a combination of pre-operative tissue expander placement, high-dose EBRT and radical resectional surgery can achieve acceptable morbidity, extended survival and low long-term recurrence in patients with RPS.


METHODS
Median (interquartile range).
White
J S
JS
Department of Surgical Oncology, Tom Baker Cancer Centre, Calgary, Canada. edmontonsurgeon@mac.com
Biberdorf
D
D
DiFrancesco
L M
LM
Kurien
E
E
Temple
W
W
D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D011878:Radiotherapy / Q000295:instrumentation*; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery*; D013526:Surgical Mesh; D015625:Tissue Expansion Devices