Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison

  • B. T. Turner University of Calgary
  • L. Hampton Cumming School of Medicine
  • D. Schiller Royal Alexandra Hospital
  • L. A. Mack University of Calgary
  • C. Robertson-More University of Calgary
  • H. Li University of Calgary
  • M. L. Quan University of Calgary
  • A. Bouchard-Fortier University of Calgary
Keywords: Sarcoma, radiotherapy

Abstract

Introduction Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection.

Methods Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan–Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture.

Results Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not.

Conclusions In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.


Author Biographies

B. T. Turner, University of Calgary
Department of Surgery
D. Schiller, Royal Alexandra Hospital
Department of Surgery
L. A. Mack, University of Calgary
Department of Surgery
C. Robertson-More, University of Calgary
General Surgery Residency Program
H. Li, University of Calgary

Departments of Oncology and Community Health Sciences

M. L. Quan, University of Calgary
Department of Surgery, Departments of Oncology and Community Health Sciences,
A. Bouchard-Fortier, University of Calgary
Department of Surgery
Published
2019-12-20
How to Cite
Turner, B. T., Hampton, L., Schiller, D., Mack, L. A., Robertson-More, C., Li, H., Quan, M. L., & Bouchard-Fortier, A. (2019). Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison. Current Oncology, 26(6). https://doi.org/10.3747/co.26.5185
Section
Surgical Oncology