title: Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of patients with localized retroperitoneal soft tissue sarcoma (STS) treated with complete surgical resection and radiation.
  
  
  METHODS
  The medical records of 83 patients were reviewed retrospectively. Sixty patients presented with primary disease and the remaining 23 had recurrence after previous surgical resection.
  
  
  RESULTS
  With a median follow-up of 47 months, the actuarial overall disease-specific survival (DSS), distant metastasis-free survival, and local control (LC) rates were 44%, 67%, and 40%, respectively. Of the 38 patients dying of disease, local disease progression was the sole site of recurrence for 16 patients and was a component of progression for another 11 patients. Multivariate analysis indicated that histologic grade was associated with the 5-year rates of DSS (low-grade, 92%; intermediate-grade, 51%; and high-grade, 41%, p = 0.006). Multivariate analysis also indicated an inferior 5-year LC rate for patients presenting with recurrent disease, positive or uncertain resection margins, and age greater than 65 years. The data did not suggest an improved local control with higher doses of external-beam radiation (EBRT) or with the specific use of intraoperative radiotherapy (IORT). Radiation-related complications (10% at 5 years) developed in 5 patients; all had received their EBRT postoperatively.
  
  
  CONCLUSIONS
  Although preoperative radiation therapy and aggressive surgical resection is well tolerated in patients, local disease progression continues to be a significant component of disease death. In this small cohort of patients, the use of higher doses of EBRT or IORT did not result in clinically apparent improvements in outcomes.
authors.affiliation: Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. mballo@mdanderson.org
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Ballo
authors.forename: Gunar K
authors.initials: GK
authors.lastname: Zagars
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Shreyaskumar R
authors.initials: SR
authors.lastname: Patel
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Trent
authors.forename: Sam
authors.initials: S
authors.lastname: Beddar
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
mesh_terms: D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*