Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: A retrospective 2-institution study Journal Article
| Authors: | Kelly, K. J.; Yoon, S. S.; Kuk, D.; Qin, L. X.; Dukleska, K.; Chang, K. K.; Chen, Y. L.; Delaney, T. F.; Brennan, M. F.; Singer, S. |
| Article Title: | Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: A retrospective 2-institution study |
| Abstract: | Objective: To compare outcomes of patients with retroperitoneal or pelvic sarcoma treated with perioperative radiation therapy (RT) versus those treated without perioperative RT. Background: RT for retroperitoneal or pelvic sarcoma is controversial, and few studies have compared outcomes with and without RT. Methods: Prospectively maintained databases were reviewed to retrospectively compare patients with primary retroperitoneal or pelvic sarcoma treated during 2003-2011. Multivariate Cox regression modelswere used to assess associations with the primary endpoints: local recurrence-free survival (LRFS) and disease-specific survival. Results: At 1 institution, 172 patients were treated with surgery alone, whereas at another institution 32 patients were treated with surgery and perioperative proton beam RT or intensity-modulated RT with or without intraoperative RT. The groups were similar in age, tumor size, grade, and margin status (all P > 0.08). The RT group had a higher percentage of pelvic tumors (P = 0.03) and a different distribution of histologies (P = 0.04). Perioperative morbidity was higher in the RT group (44% vs 16% of patients; P = 0.004). After a median follow-up of 39 months, 5-year LRFS was 91% (95% confidence interval, 79%-100%) in the RT group and 65% (57%-74%) in the surgery-only group (P = 0.02). On multivariate analysis, RT was associated with better LRFS (hazard ratio, 0.26; P = 0.03). Five-year disease-specific survival was 93% (95% confidence interval, 82%-100%) in the RT group and 85% (78%-92%) in the surgery-only group (P = 0.3). Conclusions: The addition of advanced-modality RT to surgery for primary retroperitoneal or pelvic sarcoma was associated with improved LRFS, although this did not translate into significantly better disease-specific survival. This treatment strategy warrants further investigation in a randomized trial. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. |
| Keywords: | adult; middle aged; cancer surgery; primary tumor; major clinical study; bevacizumab; doxorubicin; cancer adjuvant therapy; outcome assessment; cancer grading; tumor volume; morbidity; distant metastasis; ifosfamide; postoperative complication; length of stay; multicenter study; operation duration; urinary tract infection; pelvis tumor; age distribution; external beam radiotherapy; leiomyosarcoma; inferior cava vein; postoperative hemorrhage; surgical anatomy; disease specific survival; intensity-modulated radiation therapy; proton radiation; liposarcoma; recurrence free survival; comparative effectiveness; preoperative radiotherapy; dedifferentiated liposarcoma; local recurrence free survival; well differentiated liposarcoma; retroperitoneal sarcoma; image guided biopsy; operative blood loss; human; male; female; priority journal; article; electron beam radiation therapy; neoadjuvant radiation therapy; proton beam radiation therapy; retropertioneal sarcoma |
| Journal Title: | Annals of Surgery |
| Volume: | 262 |
| Issue: | 1 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2015-07-01 |
| Start Page: | 156 |
| End Page: | 162 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000001063 |
| PROVIDER: | scopus |
| PMCID: | PMC4465112 |
| PUBMED: | 26061213 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 15 April 2016 -- Source: Scopus |
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