What are the ESMO treatment guidelines for retroperitoneal/intra-abdominal soft tissue sarcoma (STS)?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

ESMO offers no recommendations regarding preoperative radiation therapy for resectable retroperitoneal tumors, observing that definitive evidence-based guidance is not available. ESMO notes that in any case, preoperative treatment is not intended to change the extent of surgery, but to improve the quality of surgical margins.

ESMO concludes that despite the lack of randomized trial data, neoadjuvant therapy (chemotherapy, RT, regional hyperthermia) is safe in well-selected patients and may be considered after careful review by a multidisciplinary sarcoma tumor board, particularly in patients with technically unresectable or borderline resectable retroperitoneal disease. The sensitivity of specific histologic subtypes to chemotherapy or RT should be considered as well when determining the components and sequencing of multimodality treatment plans.

ESMO finds postoperative RT to be of limited value and associated with significant morbidity, while intraoperative RT is of unproven value. The value of adjuvant chemotherapy also has not been established. [6]

Postoperative treatment with RT or reresection, if technically feasible, may be an option depending on surgical outcomes. With R0 disease (negative margins), consider postoperative RT in highly selected patients, such as those with high-grade tumors. With R1 disease (positive margins), consider postoperative RT if no preoperative RT was given or consider a boost (10-16 Gy) if preoperative RT was given. For R2 disease (macroscopic incomplete resection), consider reresection if technically feasible, otherwise consider a postoperative RT boost or follow the course for unresectable disease as described above. [1]

Decisions concerning adjuvant RT and re-resection must be tailored to specific histologic subtypes. Intraoperative placement of radio-opaque markers may assist adjuvant RT planning.


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