title: Outcomes of preoperative radiotherapy and resection of retroperitoneal sarcoma.
abstract: BACKGROUND
  Preoperative radiotherapy (RT) is an important component of the management of retroperitoneal sarcoma (RPS). We aimed to establish the feasibility of this approach by determining the accuracy of computed tomography (CT)-guided core biopsy, proportion of patients completing treatment, rates of acute toxicity and surgical complications, and treatment outcomes.
  
  
  METHODS
  This is a retrospective review. Consecutive patients presenting between January 1999 and December 2009 with a diagnosis of either primary or recurrent RPS were identified. Those patients suitable for preoperative RT and surgery were included. Exclusions included presence of metastatic disease, age under 18 years and/or paediatric histology, and treatment with palliative intent.
  
  
  RESULTS
  Twenty-four patients were included, 14 were males. Median age was 61.4 years. Twenty-three patients had Stage T2b, high-grade disease. Twenty patients were treated at initial presentation and four at first local recurrence. Five-year progression-free survival, overall survival and local recurrence rates were 48.9, 53.7 and 22%, respectively. A malignant diagnosis was confirmed in all patients who underwent CT-guided core biopsy; a diagnosis of sarcoma was reached in 90%, histological subtype correctly identified in 66%. All patients in the cohort completed preoperative RT. Grade 3 toxicity occurred in 4% of patients (n = 1). Seventy-five per cent (n = 18) proceeded to radical resection, where complete macroscopic excision was achieved in all cases. There was no perioperative mortality.
  
  
  CONCLUSIONS
  Preoperative RT has low levels of Grades 3 or 4 toxicity, and does not adversely impact surgical management. CT-guided core biopsy is an accurate means of confirming a diagnosis of RPS prior to definitive treatment.
authors.affiliation: Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. SimoneAlford@gmail.com
authors.forename: Simone
authors.initials: S
authors.lastname: Alford
authors.forename: Peter
authors.initials: P
authors.lastname: Choong
authors.forename: Sarat
authors.initials: S
authors.lastname: Chander
authors.forename: Michael
authors.initials: M
authors.lastname: Henderson
authors.forename: Gerard
authors.initials: G
authors.lastname: Powell
authors.forename: Samuel
authors.initials: S
authors.lastname: Ngan
mesh_terms: D000328:Adult; D000368:Aged; D062005:Biopsy, Large-Core Needle; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications; D015641:Radiography, Interventional; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome