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Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

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Abstract

Background

The purpose of this study was to analyze the results of treatment of retroperitoneal soft tissue sarcomas (RSTS) by surgery combined with intraoperative brachytherapy (IOBRT).

Methods

Seventy adult patients with RSTS were considered for combined treatment (surgery plus IOBRT) between June 1998 and February 2004. There were 64 (91%) recurrent tumors, and 93% of tumors exceeded 5 cm. IOBRT was performed with high-dose-rate Gammamed 12 with iridium 192 (IOBRT time range, 20–87 minutes; median, 56 minutes).

Results

After intraoperative re-evaluation, 24 patients (34%) were found to be ineligible for IOBRT because of multiple intraperitoneal recurrences, macroscopically nonradical resection, poor general condition, and technical aspects. Thirty-seven patients underwent IOBRT immediately after surgery during the same general anesthesia procedure. Nine patients underwent delayed IOBRT within 1 to 3 days after the primary operation. Ten (21.5%) of 46 patients underwent reoperation because of surgical complications. One patient died in the postoperative period. After IOBRT, 24 patients (52%) underwent adjuvant external beam radiotherapy (EBRT) to a total dose of 50 Gy. Over a median follow-up time of 20 months, the estimated 5-year overall survival and local recurrence–free survival rates in IOBRT patients were 55% and 51%, respectively. Application of adjuvant EBRT showed a favorable local control rate.

Conclusions

The scheduled combined treatment (surgery plus IOBRT) was possible to perform in 66% of RSTS cases that received surgical treatment. The complication rate was high, but we consider it acceptable because of the necessity for extensive aggressive surgical treatment in regionally advanced RSTS. EBRT seems to be an indispensable part of treatment that provides better local control.

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Acknowledgment

The authors thank M. Symonides, MD, PhD, for linguistic assistance.

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Authors and Affiliations

  1. Department of Soft Tissue/Bone Sarcoma, M. Sklodowska-Curie Cancer Center and Institute of Oncology, W.K. Roentgena Str. 5, Warsaw, 02-781, Poland

    Wirginiusz Dziewirski MD, Piotr Rutkowski MD, Zbigniew I. Nowecki MD, Maciej Sałamacha MD, Tadeusz Morysiński MD & Włodzimierz Ruka MD

  2. Department of Brachytherapy, M. Sklodowska-Curie Cancer Center and Institute of Oncology, W.K. Roentgena Str. 5, 02-781, Warsaw, Poland

    Anna Kulik MD, Maria Kawczyńska PhD, Anetta Kasprowicz MD & Jarosław Łyczek MD

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  1. Wirginiusz Dziewirski MD
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  2. Piotr Rutkowski MD
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  3. Zbigniew I. Nowecki MD
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  4. Maciej Sałamacha MD
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  8. Anetta Kasprowicz MD
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Correspondence to Piotr Rutkowski MD.

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Dziewirski, W., Rutkowski, P., Nowecki, Z.I. et al. Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas. Ann Surg Oncol 13, 245–252 (2006). https://doi.org/10.1245/ASO.2006.03.026

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  • DOI: https://doi.org/10.1245/ASO.2006.03.026

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