Preoperative chemo-radiation therapy for localised retroperitoneal sarcoma: A phase I–II study from the Italian Sarcoma Group
Introduction
Retroperitoneal soft tissue sarcoma (RPS) are rare tumours, accounting for 0.1% of all adult malignancies [1]. Surgery is the mainstay of therapy and primarily consists of resection of the tumour along with a cuff of surrounding healthy tissues [2]. This necessarily implies resection of adjacent viscera, even when they are not overtly involved [3], [4], [5], [6], [7], [8], [9].
In an effort to complement surgery, with its inherent limitations, the administration of other treatment modalities, such as radiation therapy (RT) and chemotherapy (CT), has been tried. RT proved to benefit local control in extremity soft tissue sarcoma (STS) [10], [11]. CT showed a potential impact on the outcome of high-risk extremity STS [12], [13], [14], [15].
On this basis, we decided to run a phase I–II prospective study on preoperative concomitant chemo-radiation therapy followed by surgery in localised RPS, to test whether the results of this combination were worth being further studied in a larger cohort of patients in a randomised fashion.
Section snippets
Patients
Patients were recruited from four sites in Italy. Eligibility criteria included age ⩾18 years, histologically proven localised adult-type soft tissue sarcoma (STS) located to the retroperitoneum or pelvis, primary or locally recurrent, largest diameter >5 cm, any histological grade of aggressiveness, no evidence of distant metastases, suitable for complete surgical resection and radiation. Paediatric-type sarcoma (extra-skeletal Ewing sarcoma/primitive peripheral neuroectodermal tumour,
Results
Between December 2003 and 2010, 86 patients were recruited (Fig. 1). Following central pathological review, available for 72 patients, three were found not to be eligible for the study (cellular schwannoma, aggressive angiomyxoma and non-Hodgkin lymphoma). All others were confirmed and are listed in Table 1. The clinical characteristics of the 83 eligible patients are also listed in Table 1. These patients were selected from a pool of 382 patients affected by RPS observed and treated in the
Discussion
In this multicentric phase I–II study on localised RPS, the combination of preoperative HLI and RT followed by complete surgical resection proved to be feasible in two thirds of patients selected to be eligible for the procedure. Preoperative RT could be completed in most (73/83). The observed 3-year RFS was better than expected in this patient population (56% versus 40%). Although the primary end-point of the study was met, toxicity prevented one third of patients from completing the
Conflict of interest statement
None declared.
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2020, European Journal of Surgical OncologyCitation Excerpt :However, current evidence is not conclusive. Some authors report a benefit regarding LR rates [12,17–20], whereas others failed to detect beneficial effects of IORT [21,22]. The aim of this retrospective analysis was to investigate the impact of IORT on LR rates, and to elaborate on its significance in multimodal therapy for retroperitoneal STS.