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. 2000 Mar;4(1-2):11–16. doi: 10.1155/S1357714X00000037

Adjuvant Radiation Therapy of Retroperitoneal Sarcoma: The Role of Intraoperative Radiotherapy (IORT)

Kenneth S hu 1,✉, Louis C Harrison 1,2
PMCID: PMC2408364  PMID: 18521429

Abstract

Purpose. The purpose is to review the natural history, the clinicopathological prognostic factors, and the role of adjuvant radiation therapy with particular attention to the limited but favorable experience with IORT.

Methods. Retroperitoneal sarcomas present a continuing therapeutic challenge to the oncologist. In contrast to sarcomas of the extremity and superficial trunk in which complete resection plus radiation therapy results in excellent local control, sarcomas of the retroperitoneum are difficult to resect and even if completely resected, demonstrate high rates of local relapse, the primary pattern of failure. Due to the proximity of normal organs, the delivery of therapeutic doses of adjuvant external beam radiation therapy is problematic.To deliver adequate doses (>60 Gy) of external beam to most patients would result in unacceptable toxicity. The therapeutic dilemma is unfortunate and better strategies are needed. One attractive approach has been to incorporate intraoperative radiation therapy (IORT) with maximal resection and external beam radiation.

Results and Discussion. A number of institutions have explored this approach with encouraging preliminary results.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bussières E., Stöckle E. P., Richaud P. M., Avril A. R., Kind M. M., Kantor G., Coindre J. M., Nguyen Bui B. Retroperitoneal soft tissue sarcomas: a pilot study of intraoperative radiation therapy. J Surg Oncol. 1996 May;62(1):49–56. doi: 10.1002/(SICI)1096-9098(199605)62:1<49::AID-JSO11>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
  2. Catton C. N., O'Sullivan B., Kotwall C., Cummings B., Hao Y., Fornasier V. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys. 1994 Jul 30;29(5):1005–1010. doi: 10.1016/0360-3016(94)90395-6. [DOI] [PubMed] [Google Scholar]
  3. Cody H. S., 3rd, Turnbull A. D., Fortner J. G., Hajdu S. I. The continuing challenge of retroperitoneal sarcomas. Cancer. 1981 May 1;47(9):2147–2152. doi: 10.1002/1097-0142(19810501)47:9<2147::aid-cncr2820470907>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  4. Dalton R. R., Donohue J. H., Mucha P., Jr, van Heerden J. A., Reiman H. M., Chen S. P. Management of retroperitoneal sarcomas. Surgery. 1989 Oct;106(4):725–733. [PubMed] [Google Scholar]
  5. Fein D. A., Corn B. W., Lanciano R. M., Herbert S. H., Hoffman J. P., Coia L. R. Management of retroperitoneal sarcomas: does dose escalation impact on locoregional control? Int J Radiat Oncol Biol Phys. 1995 Jan 1;31(1):129–134. doi: 10.1016/0360-3016(94)E0302-Z. [DOI] [PubMed] [Google Scholar]
  6. Gemer L. S., Trowbridge D. R., Neff J., Lin F., Reddy E., Evans R. G., Hassanein R. Local recurrence of soft tissue sarcoma following brachytherapy. Int J Radiat Oncol Biol Phys. 1991 Mar;20(3):587–592. doi: 10.1016/0360-3016(91)90074-e. [DOI] [PubMed] [Google Scholar]
  7. Glenn J., Sindelar W. F., Kinsella T., Glatstein E., Tepper J., Costa J., Baker A., Sugarbaker P., Brennan M. F., Seipp C. Results of multimodality therapy of resectable soft-tissue sarcomas of the retroperitoneum. Surgery. 1985 Mar;97(3):316–325. [PubMed] [Google Scholar]
  8. Gunderson L. L., Willett C. G., Harrison L. B., Petersen I. A., Haddock M. G. Intraoperative irradiation: current and future status. Semin Oncol. 1997 Dec;24(6):715–731. [PubMed] [Google Scholar]
  9. Harrison L. B., Enker W. E., Anderson L. L. High-dose-rate intraoperative radiation therapy for colorectal cancer. Oncology (Williston Park) 1995 Jul;9(7):679–683. [PubMed] [Google Scholar]
  10. Harrison L. B., Enker W. E., Anderson L. L. High-dose-rate intraoperative radiation therapy for colorectal cancer. Oncology (Williston Park) 1995 Aug;9(8):737–passim. [PubMed] [Google Scholar]
  11. Harrison L. B., Franzese F., Gaynor J. J., Brennan M. F. Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):259–265. doi: 10.1016/0360-3016(93)90236-o. [DOI] [PubMed] [Google Scholar]
  12. Harrison L. B., Minsky B. D., Enker W. E., Mychalczak B., Guillem J., Paty P. B., Anderson L., White C., Cohen A. M. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):325–330. doi: 10.1016/s0360-3016(98)00211-9. [DOI] [PubMed] [Google Scholar]
  13. Heslin M. J., Lewis J. J., Nadler E., Newman E., Woodruff J. M., Casper E. S., Leung D., Brennan M. F. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol. 1997 Aug;15(8):2832–2839. doi: 10.1200/JCO.1997.15.8.2832. [DOI] [PubMed] [Google Scholar]
  14. Jaques D. P., Coit D. G., Hajdu S. I., Brennan M. F. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg. 1990 Jul;212(1):51–59. doi: 10.1097/00000658-199007000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Karakousis C. P., Emrich L. J., Rao U., Krishnamsetty R. M. Feasibility of limb salvage and survival in soft tissue sarcomas. Cancer. 1986 Feb 1;57(3):484–491. doi: 10.1002/1097-0142(19860201)57:3<484::aid-cncr2820570314>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  16. Kilkenny J. W., 3rd, Bland K. I., Copeland E. M., 3rd Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg. 1996 Apr;182(4):329–339. [PubMed] [Google Scholar]
  17. Lewis J. J., Leung D., Woodruff J. M., Brennan M. F. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998 Sep;228(3):355–365. doi: 10.1097/00000658-199809000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. McGrath P. C., Neifeld J. P., Lawrence W., Jr, DeMay R. M., Kay S., Horsley J. S., 3rd, Parker G. A. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg. 1984 Aug;200(2):200–204. doi: 10.1097/00000658-198408000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rosenberg S. A., Kent H., Costa J., Webber B. L., Young R., Chabner B., Baker A. R., Brennan M. F., Chretien P. B., Cohen M. H. Prospective randomized evaluation of the role of limb-sparing surgery, radiation therapy, and adjuvant chemoimmunotherapy in the treatment of adult soft-tissue sarcomas. Surgery. 1978 Jul;84(1):62–69. [PubMed] [Google Scholar]
  20. Schray M. F., Gunderson L. L., Sim F. H., Pritchard D. J., Shives T. C., Yeakel P. D. Soft tissue sarcoma. Integration of brachytherapy, resection, and external irradiation. Cancer. 1990 Aug 1;66(3):451–456. doi: 10.1002/1097-0142(19900801)66:3<451::aid-cncr2820660309>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  21. Shaw E. G., Gunderson L. L., Martin J. K., Beart R. W., Nagorney D. M., Podratz K. C. Peripheral nerve and ureteral tolerance to intraoperative radiation therapy: clinical and dose-response analysis. Radiother Oncol. 1990 Jul;18(3):247–255. doi: 10.1016/0167-8140(90)90060-a. [DOI] [PubMed] [Google Scholar]
  22. Shiu M. H., Hilaris B. S., Harrison L. B., Brennan M. F. Brachytherapy and function-saving resection of soft tissue sarcoma arising in the limb. Int J Radiat Oncol Biol Phys. 1991 Nov;21(6):1485–1492. doi: 10.1016/0360-3016(91)90323-v. [DOI] [PubMed] [Google Scholar]
  23. Shiu M. H., Turnbull A. D., Nori D., Hajdu S., Hilaris B. Control of locally advanced extremity soft tissue sarcomas by function-saving resection and brachytherapy. Cancer. 1984 Mar 15;53(6):1385–1392. doi: 10.1002/1097-0142(19840315)53:6<1385::aid-cncr2820530628>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  24. Sindelar W. F., Kinsella T. J., Chen P. W., DeLaney T. F., Tepper J. E., Rosenberg S. A., Glatstein E. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg. 1993 Apr;128(4):402–410. doi: 10.1001/archsurg.1993.01420160040005. [DOI] [PubMed] [Google Scholar]
  25. Singer S., Corson J. M., Demetri G. D., Healey E. A., Marcus K., Eberlein T. J. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995 Feb;221(2):185–195. doi: 10.1097/00000658-199502000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Storm F. K., Mahvi D. M. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg. 1991 Jul;214(1):2–10. doi: 10.1097/00000658-199107000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Suit H. D., Mankin H. J., Wood W. C., Gebhardt M. C., Harmon D. C., Rosenberg A., Tepper J. E., Rosenthal D. Treatment of the patient with stage M0 soft tissue sarcoma. J Clin Oncol. 1988 May;6(5):854–862. doi: 10.1200/JCO.1988.6.5.854. [DOI] [PubMed] [Google Scholar]
  28. Suit H. D., Mankin H. J., Wood W. C., Proppe K. H. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer. 1985 Jun 1;55(11):2659–2667. doi: 10.1002/1097-0142(19850601)55:11<2659::aid-cncr2820551122>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  29. Suit H. D., Russell W. O., Martin R. G. Management of patients with sarcoma of soft tissue in an extremity. Cancer. 1973 May;31(5):1247–1255. doi: 10.1002/1097-0142(197305)31:5<1247::aid-cncr2820310533>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  30. Suit H. D., Russell W. O., Martin R. G. Sarcoma of soft tissue: clinical and histopathologic parameters and response to treatment. Cancer. 1975 May;35(5):1478–1483. doi: 10.1002/1097-0142(197505)35:5<1478::aid-cncr2820350537>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]
  31. Tepper J. E., Suit H. D., Wood W. C., Proppe K. H., Harmon D., McNulty P. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1984 Jun;10(6):825–830. doi: 10.1016/0360-3016(84)90383-3. [DOI] [PubMed] [Google Scholar]
  32. Willett C. G., Suit H. D., Tepper J. E., Mankin H. J., Convery K., Rosenberg A. L., Wood W. C. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer. 1991 Jul 15;68(2):278–283. doi: 10.1002/1097-0142(19910715)68:2<278::aid-cncr2820680211>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  33. Zelefsky M. J., Harrison L. B., Shiu M. H., Armstrong J. G., Hajdu S. I., Brennan M. F. Combined surgical resection and iridium 192 implantation for locally advanced and recurrent desmoid tumors. Cancer. 1991 Jan 15;67(2):380–384. doi: 10.1002/1097-0142(19910115)67:2<380::aid-cncr2820670211>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  34. Zelefsky M. J., Nori D., Shiu M. H., Brennan M. F. Limb salvage in soft tissue sarcomas involving neurovascular structures using combined surgical resection and brachytherapy. Int J Radiat Oncol Biol Phys. 1990 Oct;19(4):913–918. doi: 10.1016/0360-3016(90)90012-9. [DOI] [PubMed] [Google Scholar]
  35. Zhang G., Chen K. K., Manivel C., Fraley E. E. Sarcomas of the retroperitoneum and genitourinary tract. J Urol. 1989 May;141(5):1107–1110. doi: 10.1016/s0022-5347(17)41184-0. [DOI] [PubMed] [Google Scholar]
  36. van Doorn R. C., Gallee M. P., Hart A. A., Gortzak E., Rutgers E. J., van Coevorden F., Keus R. B., Zoetmulder F. A. Resectable retroperitoneal soft tissue sarcomas. The effect of extent of resection and postoperative radiation therapy on local tumor control. Cancer. 1994 Feb 1;73(3):637–642. doi: 10.1002/1097-0142(19940201)73:3<637::aid-cncr2820730322>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]

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