Combined modality management of retroperitoneal sarcomas: a single institution series of 121 patients
Menée à partir de données portant sur 121 patients atteints d'un sarcome rétropéritonéal traité entre 1965 et 2012 (durée médiane de suivi : 100 mois), cette étude évalue l'efficacité, du point de vue des taux de contrôle local et de survie globale à 5 ans, et les taux de complications associées à un traitement chirurgical agressif en combinaison avec une radiothérapie
Purpose : To investigate local control, survival outcomes, and complication rates of patients treated with aggressive surgery and radiation therapy (RT) for retroperitoneal sarcomas (RPS). Methods : We reviewed the medical records of 121 consecutive patients treated for RPS with surgery and RT between 1965 and 2012. The most common histology was liposarcomas (n=42, 35%). The median follow-up was 100 months (range, 20-467 months). Eighty six (71%) patients were treated for initial presentation of RPS, and 35 patients (29%) presented with and were treated for RPS recurrence. RT was preoperative in 88 patients (73%) (median dose, 50.4 Gy) and post-operative in 33 (27%) (median dose, 55 Gy). Results : The 5-year LC and OS rates were 56% and 57%, respectively. Two factors were associated with higher risk of any intra-abdominal recurrence at 5 years: positive or uncertain margins (58% vs. 30% for negative margins, P<0.001, HR 2.7 95% CI 1.6-4.8) and presenting with recurrent disease after previous resection (76% vs. 31% for de novo RPS, P<0.001, HR 4.4 95% CI 2.5-7.5). The 10-year complication rate was 5% and RT-related complications were associated with postoperative RT (P<0.001) and a RT dose ≥ 60 Gy (P<0.001). Conclusions : Intra-abdominal RPS recurrences continue to be a significant challenge despite the use of aggressive surgery and radiation therapy. Given the complications associated with postoperative radiation therapy, we recommend that preoperative radiation therapy is the preferred strategy when combined modality therapy is recommended.