title: Recurrent retroperitoneal sarcoma: impact of biology and therapy on outcomes.
abstract: BACKGROUND
  Local recurrence remains the major cause of death in patients with retroperitoneal sarcoma (RPS). There is no consensus regarding management of patients with recurrent RPS.
  
  
  METHODS
  We performed a retrospective review of patients with recurrent RPS managed at 2 tertiary care centers between 1983 and 2008. Presentation, treatments, and outcomes were analyzed.
  
  
  RESULTS
  Seventy-eight patients were identified and analyzed. Sixteen patients (22%) presented with concurrent metastatic disease; survival in this subset of patients was poor (median 12 months). Forty-eight patients underwent resection of the first local recurrence of RPS. Palliation of tumor-related symptoms was achieved in 79% with operation. Survival was significantly better in patients having complete (p = 0.001) and incomplete resection (p = 0.02) compared with patients having biopsy only. Among patients with first local recurrence, high grade tumor (p = 0.0001) and no resection (p = 0.007) were significantly associated with reduced survival. On multivariate analysis, radiation therapy, multifocality, histologic subtype, and time to local recurrence did not significantly correlate with survival. Second and third local recurrences occurred at shorter intervals compared with first local recurrence and were less likely to be completely resectable. Patients undergoing resection of second and third local recurrences had survival similar to that in patients undergoing resection of first local recurrence.
  
  
  CONCLUSIONS
  Tumor biology (high grade) is a significant prognostic factor for patients with recurrent RPS. Resection should be considered in patients with first and subsequent local recurrences (even if multifocal) of RPS because it is associated with improved survival. Operation should also be considered for palliation of symptoms in patients in whom resection is not possible.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Florida, Gainesville, FL 32610, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Jason P
authors.initials: JP
authors.lastname: Wilson
authors.forename: Brooke
authors.initials: B
authors.lastname: Apel
authors.forename: Jacquelyn
authors.initials: J
authors.lastname: Knapik
authors.forename: Walter C
authors.initials: WC
authors.lastname: Bell
authors.forename: Tad
authors.initials: T
authors.lastname: Kim
authors.forename: Kirby I
authors.initials: KI
authors.lastname: Bland
authors.forename: Edward M
authors.initials: EM
authors.lastname: Copeland
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Heslin
mesh_terms: D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome