title: Complications associated with neoadjuvant radiotherapy in the multidisciplinary treatment of retroperitoneal sarcomas.
abstract: BACKGROUND
  Retroperitoneal sarcomas (RPS) remain a therapeutic challenge due to high local recurrence rates. Preoperative RT offers theoretical advantages in the multidisciplinary care of RPS. The purpose of our study was to evaluate our experience using preoperative radiotherapy (PRT) in the treatment of RPS.
  
  
  METHODS
  This is a single-institution review of patients with RPS treated with PRT from 1994 until 2004. Three radiation oncologists and four surgical oncologists were involved. Medical records, tumor registries, and death records were reviewed.
  
  
  RESULTS
  Fourteen patients were included; nine were treated for primary presentation and five for recurrent disease. Histologic grade was grade I (n = 3), grade II (n = 3), and grade III (n = 8). Five patients received additional IORT. Radiotherapy complications were generally mild, including nausea (n = 3), diarrhea (n = 1), dehydration (n = 1), anemia (n = 1), and skin changes (n = 1); one required early cessation due to nausea. Thirteen patients had gross negative margins; while 7/13 had negative microscopic margins. Operative complications included anastomotic bleeding (n = 1), fluid collections (n = 2), ileus (n = 3), ascites (n = 2), temporary leg weakness (n = 1), and uncomplicated wound infections (n = 2). In patients with R0 or R1 resections, one and two year local control rates were 64 and 50%. Overall survival for all patients was 90% at 1 year and 74% at 2 years with median survival of 21 months.
  
  
  CONCLUSIONS
  PRT and IORT can be administered effectively in carefully selected patients with resectable RPS. Larger multi-center studies are needed to delineate the role of PRT and IORT to improve local recurrence and survival rates in the treatment of RPS.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of North Carolina School of Medicine, 3010 Old Clinic Building, CB #7213, Chapel Hill, NC 27599, USA.
authors.forename: Abigail S
authors.initials: AS
authors.lastname: Caudle
authors.forename: Joel E
authors.initials: JE
authors.lastname: Tepper
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Calvo
authors.forename: Michael O
authors.initials: MO
authors.lastname: Meyers
authors.forename: Lav K
authors.initials: LK
authors.lastname: Goyal
authors.forename: William G
authors.initials: WG
authors.lastname: Cance
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011300:Preoperative Care; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D012509:Sarcoma / Q000532:radiotherapy*