title: Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: long-term results of a prospective trial.
abstract: BACKGROUND
  Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.
  
  
  METHODS
  From June 1996 to October 2000, eligible patients with resectable RPS were entered onto a phase II trial of preoperative XRT (45-50 Gray) plus postoperative BT (20-25 Gray). Kaplan Meier survival curves were constructed and compared by log rank analysis (SPSS 21.0).
  
  
  RESULTS
  All 40 patients had preoperative XRT and total gross resection as part of the prospective trial, nineteen received BT (48%). Median follow-up was 106 months. For the entire cohort, OS at 5 and 10 years was 70% and 64%, respectively; RFS at 5 and 10 years was 69% and 63%. RFS was significantly reduced in high versus low grade RPS at 5 years (53% vs. 88%, p=0.016), but not at 10 years (53% vs. 75%, p=0.079). RFS and OS at 10 years were reduced in patients who presented with recurrent compared to primary disease (RFS 30% vs. 74%, p=0.015; OS 36% vs. 76%, p=0.036). At 10 years, neither RFS nor OS was improved in patients who received BT compared to those who did not (RFS 56% vs. 69%, p=0.54; OS 52% vs.76%, p=0.23).
  
  
  CONCLUSIONS
  In this prospective trial with mature follow-up, long-term OS and RFS in patients who underwent combined preoperative XRT plus resection of RPS compare favourably with those reported in retrospective institutional and population-based series. Postoperative BT was associated with unacceptable toxicity and did not contribute to disease control.
  
  
  CONCLUSIONS
  In a prospective trial with mature follow-up, preoperative radiation combined with complete resection of retroperitoneal sarcoma resulted in favourable long-term RFS and OS compared to historical controls. Dose escalation with postoperative brachytherapy was not associated with better disease control.
authors.affiliation: The University of Toronto Sarcoma Group, Princess Margaret Hospital and Mount Sinai Hospital, Canada; Department of Surgery, University of Toronto, Canada.
authors.forename: Myles J F
authors.initials: MJ
authors.lastname: Smith
authors.affiliation: Department of Surgery, Adelaide and Meath Hospital, Dublin 24, Ireland.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Ridgway
authors.affiliation: The University of Toronto Sarcoma Group, Princess Margaret Hospital and Mount Sinai Hospital, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.affiliation: The University of Toronto Sarcoma Group, Princess Margaret Hospital and Mount Sinai Hospital, Canada; Department of Surgery, University of Toronto, Canada.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cannell
authors.affiliation: The University of Toronto Sarcoma Group, Princess Margaret Hospital and Mount Sinai Hospital, Canada; Department of Radiation Oncology, University of Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: The Peterborough Clinic, Peterborough, Canada.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Mikula
authors.affiliation: The R. S. McLaughlin Durham Regional Cancer Centre, Oshawa, Canada.
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Jones
authors.affiliation: The University of Toronto Sarcoma Group, Princess Margaret Hospital and Mount Sinai Hospital, Canada; Department of Surgery, University of Toronto, Canada. Electronic address: cswallow@mtsinai.on.ca.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011184:Postoperative Period; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*
keywords: Brachytherapy; Clinical trial; Local neoplasm recurrence; Operative surgical procedures; Phase II; Radioisotope; Radiotherapy; Sarcoma; Soft tissue; Targeted; Toxic potential