title: Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel.
abstract: OBJECTIVE
  Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS.
  
  
  METHODS
  An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available.
  
  
  RESULTS
  Treatment guidelines for preoperative RT for RPS are presented.
  
  
  CONCLUSIONS
  An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy and toxicity.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: ebaldini@partners.org.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Baldini
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Dian
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Rick L M
authors.initials: RL
authors.lastname: Haas
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.affiliation: Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Indelicato
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Roberge
authors.affiliation: Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Kilian
authors.initials: K
authors.lastname: Salerno
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC.
authors.forename: Curtiland
authors.initials: C
authors.lastname: Deville
authors.affiliation: Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.affiliation: Department of Radiotherapy, Institut Gustave-Roussy, Villejuif, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Le Pechoux
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: DeLaney
mesh_terms: D006498:Hepatectomy; D006801:Humans; D009392:Nephrectomy; D058958:Organs at Risk / Q000000981:diagnostic imaging; D010348:Patient Care Team; D011300:Preoperative Care; D011859:Radiography; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D012186:Retroperitoneal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D012509:Sarcoma / Q000532:radiotherapy* / Q000601:surgery