title: Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas.
abstract: OBJECTIVE
  To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS).
  
  
  BACKGROUND
  Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.
  
  
  METHODS
  The 1998-2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.
  
  
  RESULTS
  A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).
  
  
  CONCLUSIONS
  Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.
authors.affiliation: Departments of *Surgery †Radiation Oncology, and ‡Pharmacology and Cancer Biology, Duke University, Durham, NC.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome