Treatment Guidelines for Pre-operative Radiation Therapy (RT) for Retroperitoneal Sarcoma (RPS): Preliminary Consensus of an International Expert Panel
Cet article présente les recommandations d'un groupe d'experts internationaux sur la radiothérapie pré-opératoire pour traiter un sarcome rétropéritonéal
Purpose : Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Pre-operative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many employ pre-operative RT for RPS, and while this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for pre-operative RT for RPS. Methods and Materials : An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of literature related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high quality published data on the subject of RT for RPS, consensus recommendations are largely based on expert opinion derived from clinical experience and extrapolation of relevant published literature. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results : Treatment guidelines for pre-operative RT for RPS are presented. Conclusions : An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for pre-operative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence, and thus, are best regarded as preliminary. We would like to re-emphasize that the role of pre-operative RT for RPS has not been proven, and we await data from the EORTC STRASS randomized trial of surgery alone vs pre-operative RT followed by surgery. Further data are also anticipated pertaining to normal tissue dose constraints—particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy and toxicity.
http://www.redjournal.org/article/S0360-3016(15)00180-7/abstract