International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: sarcomaLong-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma
Introduction
The treatment of retroperitoneal soft tissue sarcoma by surgery alone has resulted in poor local control and survival 1, 2, 3. Because of the infiltrative nature of these tumors and their anatomic origin, wide resection margins are difficult to achieve. The efficacy of postoperative external beam irradiation (EBRT) is limited by the inability to deliver adequate doses of irradiation secondary to the dose tolerance limits of small bowel, spinal cord, stomach, kidney, and liver. The experience with extremity soft tissue sarcoma shows that a high probability of local control can be achieved with doses of 60 to 70 Gy (4). Intraoperative electron beam radiotherapy (IOERT) in combination with EBRT and surgery has been utilized in the management of these tumors at the Massachusetts General Hospital (MGH) to overcome these dose limitations (5). This report expands and updates our experience with this treatment approach.
Section snippets
Methods and materials
From 1980 to 1996, 37 patients with retroperitoneal sarcoma were treated with curative intent. Of these, 29 patients had primary sarcoma, and 8 patients had recurrent disease. There were 20 women and 17 men treated. The median age was 45 years, with a range of 10 to 84 years. All patients were fully evaluated preoperatively by physical examination and computerized tomography (CT scan) of the chest and abdomen and had no metastatic disease. Surgical procedures before preoperative radiotherapy
Results
After preoperative EBRT, 35 patients (95%) underwent exploratory laparotomy: 29 (79%) had a complete resection, 4 (11%) had a partial resection, and 2 (5%) were found to be unresectable secondary to sarcomatosis. Two patients did not undergo further surgery because of tumor progression during radiotherapy. Twenty of 37 patients received IOERT. IOERT was not administered for the following reasons: sarcomatosis or other metastases (3 patients), tumor progression during EBRT (2 patients), or
Discussion
In the initial publication (5) of the MGH experience in the treatment of retroperitoneal sarcoma using IOERT, 17 of 20 patients were able to undergo resection; of these, 14 had a complete resection. The 4-year actuarial local control and disease-free survival of resectable patients was 81% and 64%, respectively. Of these 17 patients, 12 received IOERT, and 5 did not. Three patients who received IOERT had a local recurrence. The 5 patients who had only EBRT were locally controlled. During the
References (11)
- et al.
Retroperitoneal soft tissue sarcomasa pilot study of intraoperative radiation therapy
J Surg Oncol
(1996) - et al.
The continuing challenge of retroperitoneal sarcomas
Cancer
(1981) - et al.
Retroperitoneal sarcomas and their management
Arch Surg
(1995) - et al.
Diagnosis and management of retroperitoneal soft-tissue sarcoma [Review]
Ann Surg
(1991) - et al.
Treatment of the patient with MO soft tissue sarcoma
J Clin Oncol
(1988)
Cited by (186)
Progress in Retroperitoneal Sarcoma Management: Surgical and Radiotherapy Approaches
2024, Seminars in Radiation OncologyPancreatic solitary myxoid liposarcoma mimicking solid pseudopapillary neoplasm
2024, Asian Journal of SurgeryNeoadjuvant Simultaneous Integrated Boost Radiation Therapy Improves Clinical Outcomes for Retroperitoneal Sarcoma
2023, International Journal of Radiation Oncology Biology PhysicsInitial Clinical Experience With Novel Directional Low-dose Rate Brachytherapy for Retroperitoneal Sarcoma
2021, Journal of Surgical ResearchIntraoperative radiation therapy (IORT) for soft tissue sarcoma – ESTRO IORT Task Force/ACROP recommendations
2020, Radiotherapy and Oncology