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The role of radiation therapy in the management of primary retroperitoneal sarcoma: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association

医学 随机对照试验 围手术期 脂肪肉瘤 肉瘤 回顾性队列研究 软组织肉瘤 放射治疗 外科 内科学 肿瘤科 放射科 病理
作者
Anna Lawless,Deborah Zhou,Joshua McDonough,Helen Lo,Jasmine Mar,Smaro Lazarakis,Iain Ward,Joanna Connor,Stephen R. Thompson,David J. Coker,Andrew T. Johnston,David Gyorki,Angela Hong
出处
期刊:Cancer Treatment Reviews [Elsevier BV]
卷期号:120: 102620-102620 被引量:2
标识
DOI:10.1016/j.ctrv.2023.102620
摘要

While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma.A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies.In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity.In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.
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