title: Excellent local control with preoperative radiation therapy, surgical resection, and intra-operative electron radiation therapy for retroperitoneal sarcoma.
abstract: OBJECTIVE
  To examine the value of surgical resection combined with preoperative external beam radiation therapy and intraoperative radiation therapy (Surg-RT) for retroperitoneal sarcoma (RPS).
  
  
  METHODS
  Review of 63 consecutive patients with RPS from 1996 to 2011.
  
  
  RESULTS
  Thirty-seven patients (59%) underwent Surg-RT and 26 (41%) had surgery alone. 51% of tumors were high grade and 36% of patients had locally recurrent disease. Final margin status was: R0 73%, R1 16%, R2 6%, and unknown 5%. Of those with R0 resections, 67% received Surg-RT. Median follow-up was 45 months. The 5-year local control rate was 89% for Surg-RT patients and 46% for surgery alone patients (P = 0.03). On multivariate analysis, Surg-RT was the only variable associated with a lower risk of LR (HR 0.19; CI 0.05-0.69, P = 0.003). The actuarial 5-year OS was 60% for patients receiving either Surg-RT or surgery alone.
  
  
  CONCLUSIONS
  The combination of pre-operative radiation, surgical resection, and intraoperative radiation produces excellent local disease control for RPS. Combination therapy was associated with improved local control but not with overall survival.
authors.affiliation: Department of Surgery, Mayo Clinic in Arizona, Phoenix, Arizona.
authors.forename: Chee-Chee H
authors.initials: CC
authors.lastname: Stucky
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Ashman
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Gunderson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004583:Electrons / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D055815:Young Adult
keywords: intraoperative radiation; radiation therapy; retroperitoneal; sarcoma