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Significance of intraoperative radiation therapy and high cumulative radiation doses in retroperitoneal soft tissue sarcoma

Introduction - In retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Stil...

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Main Authors: Willis, Franziska (Author) , Schimmack, Simon (Author) , Uhl, Matthias (Author) , Häfner, Matthias (Author) , Mechtersheimer, Gunhild (Author) , Hinz, Ulf (Author) , Schmidt, Thomas (Author) , Debus, Jürgen (Author) , Fröhling, Stefan (Author) , Schneider, Martin (Author)
Format: Article (Journal)
Language:English
Published: 2020
In: European journal of surgical oncology
Year: 2019, Volume: 46, Issue: 5, Pages: 905-913
ISSN:1532-2157
DOI:10.1016/j.ejso.2019.12.014
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.ejso.2019.12.014
Verlag, lizenzpflichtig, Volltext: http://www.sciencedirect.com/science/article/pii/S0748798319315070
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Author Notes:Franziska Willis, Simon Schimmack, Matthias Uhl, Matthias F. Haefner, Gunhild Mechtersheimer, Ulf Hinz, Thomas Schmidt, Jürgen Debus, Stefan Fröhling, Martin Schneider
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Summary:Introduction - In retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Still, the significance of IORT in multimodal treatment of retroperitoneal STS remains unclear. - Material and methods - Patients undergoing resection of primary or recurrent retroperitoneal STS at the University of Heidelberg Department of General, Visceral and Transplantation Surgery were retrospectively analyzed. Univariate Kaplan-Meyer and multivariate Cox regression analyses were performed to identify predictors of LR-free survival and to investigate the impact of IORT and high cumulative radiation doses. Analyses with propensity-score matched subgroups for IORT and cumulative radiation dose were performed to control for selection bias. Subgroup analyses for patients with retroperitoneal liposarcoma were likewise performed. - Results - 272 patients were identified. Recurrent tumors, histology of dedifferentiated liposarcoma or unclassified sarcoma and microscopically incomplete resection were associated with decreased LR-free survival. In liposarcoma, only recurrent and dedifferentiated tumors were confirmed as poor prognostic factors concerning LR. IORT and cumulative radiation doses exceeding 60 Gy did not influence LR rates (estimated 5-year LR-free survival: IORT: 39%, non-IORT: 46%; p = 0.79). - Conclusion - In this retrospective evaluation, additional application of IORT does not significantly influence oncological outcome in retroperitoneal soft tissue sarcoma. Randomized trials are needed to clarify the benefit of IORT.
Item Description:Available online 17 December 2019
Gesehen am 22.04.2020
Physical Description:Online Resource
ISSN:1532-2157
DOI:10.1016/j.ejso.2019.12.014

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