Yonsei Medical Journal

  • 제59권9호
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  • Pages.1049-1056
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  • 2018
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  • 0513-5796(pISSN)
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  • 1976-2437(eISSN)
연세대학교의과대학 (Yonsei Univ College Medicine)
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Efficacy of Postoperative Radiotherapy Using Modern Techniques in Patients with Retroperitoneal Soft Tissue Sarcoma

  • Kim, Hyun Ju (Department of Radiation Oncology, Gachon University Gil Medical Center) ;
  • Koom, Woong Sub (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Jaeho (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Hyo Song (Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • 투고 : 2018.06.20
  • 심사 : 2018.08.21
  • 발행 : 2018.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

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 ${\leq}2$ acute toxicities were observed in 63% of patients, but no acute toxicity ${\geq}$ 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.

키워드

참고문헌

  1. Clark JA, Tepper JE. Role of radiation therapy in retroperitoneal sarcomas. Oncology (Williston Park) 1996;10:1867-72.
  2. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg 2003;238:358-70.
  3. Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg 1991;214:2-10.
  4. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998;228:355-65. https://doi.org/10.1097/00000658-199809000-00008
  5. Stoeckle E, Coindre JM, Bonvalot S, Kantor G, Terrier P, Bonichon F, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001;92:359-68. https://doi.org/10.1002/1097-0142(20010715)92:2<359::AID-CNCR1331>3.0.CO;2-Y
  6. Toulmonde M, Bonvalot S, Meeus P, Stoeckle E, Riou O, Isambert N, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 2014;25:735-42. https://doi.org/10.1093/annonc/mdt577
  7. Van De Voorde L, Delrue L, van Eijkeren M, De Meerleer G. Radiotherapy and surgery-an indispensable duo in the treatment of retroperitoneal sarcoma. Cancer 2011;117:4355-64. https://doi.org/10.1002/cncr.26071
  8. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996;14:859-68. https://doi.org/10.1200/JCO.1996.14.3.859
  9. Yang JC, Chang AE, Baker AR, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998;16:197-203. https://doi.org/10.1200/JCO.1998.16.1.197
  10. Bishop AJ, Zagars GK, Torres KE, Hunt KK, Cormier JN, Feig BW, et al. Combined modality management of retroperitoneal sarcomas: a single-institution series of 121 patients. Int J Radiat Oncol Biol Phys 2015;93:158-65. https://doi.org/10.1016/j.ijrobp.2015.04.047
  11. Rosenberg SA, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant chemotherapy. Ann Surg 1982;196:305-15. https://doi.org/10.1097/00000658-198209000-00009
  12. Heslin MJ, Lewis JJ, Nadler E, Newman E, Woodruff JM, Casper ES, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997;15:2832-9. https://doi.org/10.1200/JCO.1997.15.8.2832
  13. Sampath S, Hitchcock YJ, Shrieve DC, Randall RL, Schultheiss TE, Wong JY. Radiotherapy and extent of surgical resection in retroperitoneal soft-tissue sarcoma: multi-institutional analysis of 261 patients. J Surg Oncol 2010;101:345-50.
  14. Pierie JP, Betensky RA, Choudry U, Willett CG, Souba WW, Ott MJ. Outcomes in a series of 103 retroperitoneal sarcomas. Eur J Surg Oncol 2006;32:1235-41. https://doi.org/10.1016/j.ejso.2006.07.002
  15. Le Pechoux C, Musat E, Baey C, Al Mokhles H, Terrier P, Domont J, et al. Should adjuvant radiotherapy be administered in addition to front-line aggressive surgery (FAS) in patients with primary retroperitoneal sarcoma? Ann Oncol 2013;24:832-7. https://doi.org/10.1093/annonc/mds516
  16. Trovik LH, Ovrebo K, Almquist M, Haugland HK, Rissler P, Eide J, et al. Adjuvant radiotherapy in retroperitoneal sarcomas. A Scandinavian Sarcoma Group study of 97 patients. Acta Oncol 2014;53:1165-72. https://doi.org/10.3109/0284186X.2014.921723
  17. Choi AH, Barnholtz-Sloan JS, Kim JA. Effect of radiation therapy on survival in surgically resected retroperitoneal sarcoma: a propensity score-adjusted SEER analysis. Ann Oncol 2012;23:2449-57. https://doi.org/10.1093/annonc/mdr616
  18. Pawlik TM, Pisters PW, Mikula L, Feig BW, Hunt KK, Cormier JN, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or highgrade retroperitoneal soft tissue sarcoma. Ann Surg Oncol 2006;13:508-17. https://doi.org/10.1245/ASO.2006.05.035
  19. Tzeng CW, Fiveash JB, Popple RA, Arnoletti JP, Russo SM, Urist MM, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer 2006;107:371-9. https://doi.org/10.1002/cncr.22005
  20. Zagars GK, Ballo MT, Pisters PW, Pollock RE, Patel SR, Benjamin RS. Preoperative vs. postoperative radiation therapy for soft tissue sarcoma: a retrospective comparative evaluation of disease outcome. Int J Radiat Oncol Biol Phys 2003;56:482-8. https://doi.org/10.1016/S0360-3016(02)04510-8
  21. Cheng EY, Dusenbery KE, Winters MR, Thompson RC. Soft tissue sarcomas: preoperative versus postoperative radiotherapy. J Surg Oncol 1996;61:90-9. https://doi.org/10.1002/(SICI)1096-9098(199602)61:2<90::AID-JSO2>3.0.CO;2-M
  22. Sampath S, Schultheiss TE, Hitchcock YJ, Randall RL, Shrieve DC, Wong JY. Preoperative versus postoperative radiotherapy in softtissue sarcoma: multi-institutional analysis of 821 patients. Int J Radiat Oncol Biol Phys 2011;81:498-505. https://doi.org/10.1016/j.ijrobp.2010.06.034
  23. Pollack A, Zagars GK, Goswitz MS, Pollock RA, Feig BW, Pisters PW. Preoperative vs. postoperative radiotherapy in the treatment of soft tissue sarcomas: a matter of presentation. Int J Radiat Oncol Biol Phys 1998;42:563-72. https://doi.org/10.1016/S0360-3016(98)00277-6
  24. Zlotecki RA, Katz TS, Morris CG, Lind DS, Hochwald SN. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol 2005;28:310-6. https://doi.org/10.1097/01.coc.0000158441.96455.31
  25. Nussbaum DP, Rushing CN, Lane WO, Cardona DM, Kirsch DG, Peterson BL, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 2016;17:966-75. https://doi.org/10.1016/S1470-2045(16)30050-X
  26. Gilbeau L, Kantor G, Stoeckle E, Lagarde P, Thomas L, Kind M, et al. Surgical resection and radiotherapy for primary retroperitoneal soft tissue sarcoma. Radiother Oncol 2002;65:137-43. https://doi.org/10.1016/S0167-8140(02)00283-9
  27. Baldini EH, Wang D, Haas RL, Catton CN, Indelicato DJ, Kirsch DG, et al. Treatment guidelines for preoperative radiation therapy for retroperitoneal sarcoma: preliminary consensus of an international expert panel. Int J Radiat Oncol Biol Phys 2015;92:602-12. https://doi.org/10.1016/j.ijrobp.2015.02.013
  28. Fein DA, Corn BW, Lanciano RM, Herbert SH, Hoffman JP, Coia LR. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control? Int J Radiat Oncol Biol Phys 1995;31:129-34. https://doi.org/10.1016/0360-3016(94)E0302-Z
  29. Ballo MT, Zagars GK, Pollock RE, Benjamin RS, Feig BW, Cormier JN, et al. Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Radiat Oncol Biol Phys 2007;67:158-63. https://doi.org/10.1016/j.ijrobp.2006.08.025

피인용 문헌

  1. Perioperative radiotherapy versus surgery alone for retroperitoneal sarcomas: a systematic review and meta-analysis vol.54, pp.1, 2018, https://doi.org/10.2478/raon-2020-0012
  2. Intraoperative radiotherapy with low energy x-rays for primary and recurrent soft-tissue sarcomas vol.15, pp.1, 2020, https://doi.org/10.1186/s13014-020-01559-7