Proton-beam, intensity-modulated, and/or intraoperative electron radiation therapy combined with aggressive anterior surgical resection for retroperitoneal sarcomas.

Published

Journal Article

BACKGROUND: We sought to reduce local recurrence for retroperitoneal sarcomas by using a coordinated strategy of advanced radiation techniques and aggressive en-bloc surgical resection. METHODS: Proton-beam radiation therapy (PBRT) and/or intensity-modulated radiation therapy (IMRT) were delivered to improve tumor target coverage and spare selected adjacent organs. Surgical resection of tumor and adjacent organs was performed to obtain a disease-free anterior margin. Intraoperative electron radiation therapy (IOERT) was delivered to any close posterior margin. RESULTS: Twenty patients had primary tumors and eight had recurrent tumors. Tumors were large (median size 9.75 cm), primarily liposarcomas and leiomyosarcomas (71%), and were mostly of intermediate or high grade (81%). PBRT and/or IMRT were delivered to all patients, preferably preoperatively (75%), to a median dose of 50 Gy. Surgical resection included up to five adjacent organs, most commonly the colon (n = 7) and kidney (n = 7). Margins were positive for disease, usually posteriorly, in 15 patients (54%). IOERT was delivered to the posterior margin in 12 patients (43%) to a median dose of 11 Gy. Surgical complications occurred in eight patients (28.6%), and radiation-related complications occurred in four patients (14%). After a median follow-up of 33 months, only two patients (10%) with primary disease experienced local recurrence, while three patients (37.5%) with recurrent disease experienced local recurrence. CONCLUSIONS: Aggressive resection of retroperitoneal sarcomas can achieve a disease-negative anterior margin. PBRT and/or IMRT with IOERT may possibly deliver sufficient radiation dose to the posterior margin to control microscopic residual disease. This strategy may minimize radiation-related morbidity and reduce local recurrence, especially in patients with primary disease.

Full Text

Duke Authors

Cited Authors

  • Yoon, SS; Chen, Y-L; Kirsch, DG; Maduekwe, UN; Rosenberg, AE; Nielsen, GP; Sahani, DV; Choy, E; Harmon, DC; DeLaney, TF

Published Date

  • June 2010

Published In

Volume / Issue

  • 17 / 6

Start / End Page

  • 1515 - 1529

PubMed ID

  • 20151216

Pubmed Central ID

  • 20151216

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

Digital Object Identifier (DOI)

  • 10.1245/s10434-010-0935-1

Language

  • eng

Conference Location

  • United States