title: Preoperative intensity modulated radiation therapy for retroperitoneal sarcoma.
abstract: The use of intensity modulated radiation therapy (IMRT) has allowed for the administration of high doses to retroperitoneal sarcomas (RSTS) while limiting toxicity to adjacent organs. The purpose of our study is to assess the outcome and toxicities of patients with RSTS treated with neo-adjuvant external beam radiation (EBRT) therapy using IMRT. This is a retrospective study of 21 patients treated with preoperative IMRT for primary or recurrent RSTS between 2005 and 2011. Overall survival (OS) and local recurrence free survival (LRFS) were computed using the Kaplan-Meier method (log-rank test). Acute and chronic toxicities were assessed using the CTCAE v. 3 criteria. The actuarial 2 and 3-year OS was 66% for both and the 5-year OS was 51%. As for LRFS it was 57% at 2 and 3-year and 51% for the 5-year LRFS. Factors predictive for local control were microscopically negative margins (p = 0.022), a median tumor diameter <15 cm (p = 0.007) and pathology of liposarcoma (p = 0.021). Furthermore, patients treated for recurrent disease fared worse (p = 0.04) in local control than patients treated for primary disease. As for OS, patients treated for Grade 1 histology had a better outcome (p 5 0.05). EBRT was generally well tolerated. Acute gastrointestinal (GI) Grade 1 or 2 toxicities occurred in 33% of patients and one patient had unexplained post-radiation Grade 2 fever that resolved after tumor resection. As for chronic toxicities 24% of our patients presented Grade 1 GI toxicity and one patient presented Grade 3 small bowel stenosis not clearly due to radiation toxicity. Despite the location and volume of the tumors treated, preoperative IMRT was very well tolerated in our patients with retroperitoneal sarcoma. Unfortunately local recurrences remain common and dose escalation is to be considered.
authors.affiliation: Department of Radiation Oncology, CHUM - Hopital Notre-Dame, 1560 Sherbrooke St. E., Montreal, Quebec, H2L 4M1, Canada. daniel.taussky.chum@ssss.gouv.qc.ca.
authors.forename: Nancy
authors.initials: N
authors.lastname: El-Bared
authors.forename: Daniel
authors.initials: D
authors.lastname: Taussky
authors.forename: Selma
authors.initials: S
authors.lastname: Mehiri
authors.forename: Erika
authors.initials: E
authors.lastname: Patocskai
authors.forename: David
authors.initials: D
authors.lastname: Roberge
authors.forename: David
authors.initials: D
authors.lastname: Donath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008080:Liposarcoma / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D011300:Preoperative Care; D011832:Radiation Injuries; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
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