Yonsei Med J.  2018 Nov;59(9):1049-1056. 10.3349/ymj.2018.59.9.1049.

Efficacy of Postoperative Radiotherapy Using Modern Techniques in Patients with Retroperitoneal Soft Tissue Sarcoma

• Kim HJ
• Koom WS
• Cho J
• Kim HS
• Suh CO

• KMID: 2422489
• DOI: http://doi.org/10.3349/ymj.2018.59.9.1049

Abstract

PURPOSE
Local recurrence is the most common cause of failure in retroperitoneal soft tissue sarcoma patients after surgical resection. Postoperative radiotherapy (PORT) is infrequently used due to its high complication risk. We investigated the efficacy of PORT using modern techniques in patients with retroperitoneal soft tissue sarcoma.
MATERIALS AND METHODS
Eighty patients, who underwent surgical resection for non-metastatic primary retroperitoneal soft tissue sarcoma at the Yonsei Cancer Center between 1994 and 2015, were retrospectively reviewed. Thirty-eight (47.5%) patients received PORT: three-dimensional conformal radiotherapy in 29 and intensity-modulated radiotherapy in nine patients. Local failure-free survival (LFFS), overall survival (OS), and RT-related toxicities were investigated.
RESULTS
Median follow-up was 37.1 months (range, 5.8-207.9). Treatment failure occurred in 47 (58.8%) patients including local recurrence in 33 (41.3%), distant metastasis in eight (10%), and both occurred in six (7.5%) patients. The 2-year and 5-year LFFS rates were 63.9% and 47.9%, respectively. The 2-year and 5-year OS rates were 87.5% and 71.1%. The 5-year LFFS rate was significantly higher in PORT group than in no-PORT group (74.2% vs. 24.3%, p < 0.001). In multivariate analysis, PORT was the only independent prognostic factor for LFFS. However, there was no significant correlation between RT dose and LFFS. OS showed no significant difference between the two groups. Grade ≤2 acute toxicities were observed in 63% of patients, but no acute toxicity ≥grade 3 was observed.
CONCLUSION
PORT using modern technique markedly reduced local recurrence in retroperitoneal sarcoma patients, with low toxicity. The optimal RT technique, in terms of RT dose and target volume, should be further investigated.

Keyword

Retroperitoneal sarcoma; postoperative radiotherapy; local recurrence; toxicity

MeSH Terms

Follow-Up Studies
Humans
Multivariate Analysis
Neoplasm Metastasis
Radiotherapy*
Radiotherapy, Conformal
Radiotherapy, Intensity-Modulated
Recurrence
Retrospective Studies
Sarcoma*
Treatment Failure

Figure

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  Fig. 1 Examples of radiotherapy (RT) plan of (A) two-dimensional RT, (B) three-dimensional conformal RT, and (C) intensity-modulated RT.

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  Fig. 2 Kaplan-Meire curves for (A) LFFS and (B) OS. LFFS, local failure-free survival; OS, overall survival.

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  Fig. 3 Pattern of failures according to resection margin and use of postoperative RT. RT, radiotherapy; LF, local failure; DM, distant metastasis.

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