Efficacy of Postoperative Radiotherapy Using Modern Techniques in Patients with Retroperitoneal Soft Tissue Sarcoma
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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 ofPORT 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 tissuesarcoma at the Yonsei Cancer Center between 1994 and 2015, were retrospectively reviewed. Thirty-eight (47.5%) patients receivedPORT: 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 localrecurrence in 33 (41.3%), distant metastasis in eight (10%), and both occurred in six (7.5%) patients. The 2-year and 5-year LFFSrates 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 significantlyhigher in PORT group than in no-PORT group (74.2% vs. 24.3%, p<0.001). In multivariate analysis, PORT was the only independentprognostic factor for LFFS. However, there was no significant correlation between RT dose and LFFS. OS showed nosignificant 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 lowtoxicity. The optimal RT technique, in terms of RT dose and target volume, should be further investigated.
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 ofPORT 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 tissuesarcoma at the Yonsei Cancer Center between 1994 and 2015, were retrospectively reviewed. Thirty-eight (47.5%) patients receivedPORT: 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 localrecurrence in 33 (41.3%), distant metastasis in eight (10%), and both occurred in six (7.5%) patients. The 2-year and 5-year LFFSrates 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 significantlyhigher in PORT group than in no-PORT group (74.2% vs. 24.3%, p<0.001). In multivariate analysis, PORT was the only independentprognostic factor for LFFS. However, there was no significant correlation between RT dose and LFFS. OS showed nosignificant 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 lowtoxicity. The optimal RT technique, in terms of RT dose and target volume, should be further investigated.
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