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Significance of intraoperative radiation therapy and high cumulative radiation doses in retroperitoneal soft tissue sarcoma
Institution:1. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany;2. Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany;3. Institute of Pathology, University of Heidelberg, Heidelberg, Germany;4. Departement of Translation Medical Oncology, National Center for Tumor Diseases Heidelberg and German Cancer Research Center, Heidelberg, Germany;1. Anhui Medical University, Anhui Provincial Hospital, Hefei, 230001, China;2. Department of Obstetrics and Gynecology, The First Affiliated Hospital of University of Science & Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province, 230001, China;3. Organ Transplantation Center, The First Affiliated Hospital of University of Science & Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province, 230001, China;4. Department of Anesthesiology, The First Affiliated Hospital of University of Science & Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province, 230001, China;5. Operation Room, The First Affiliated Hospital of University of Science & Technology of China, Anhui Provincial Hospital, Hefei, Anhui Province, 230001, China;1. National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany;2. Department of Dermatology, Heidelberg University, Mannheim, Germany;3. Skin Cancer Unit, German Cancer Research Center, Heidelberg, Germany;4. Institute of Pathology and Neuropathology, Eberhard-Karls-University Tuebingen and National Center for Pleura and Peritoneum, University of Tuebingen, Germany;5. Department of Dermatology, University Hospital Essen, Essen, Germany;6. Department of Dermatology, University Hospital Cologne, Cologne, Germany;7. Core Facility Unit Light Microscopy, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;8. Private Laboratory of Dermatohistopathology, Mönchhofstraße 52, 69120, Heidelberg, Germany;3. Chair of Plant Systems Biology, Technische Universität München, Emil-Ramann-Strasse 8, 85354 Freising, Germany;4. Chair of Proteomics and Bioanalytics, Technische Universität München, Emil-Erlenmeyer-Forum 5, 85354 Freising, Germany;1. Department of Dermatology, University of Duisburg-Essen, Essen, Germany;2. Department of Dermatology, University of Berlin Charité, Berlin, Germany;3. Department of Translational Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany;4. Section for Personalized Oncology, Heidelberg University Hospital, Heidelberg, Germany;5. German Cancer Consortium (DKTK), Heidelberg, Germany;6. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany;7. Institute of Pathology, University of Duisburg-Essen, Essen, Germany;8. Translational Skin Cancer Research, German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Essen, Germany;9. German Cancer Research Center (DKFZ), Heidelberg, Germany
Abstract:IntroductionIn retroperitoneal soft tissue sarcoma (STS) local recurrence (LR) rates remain high despite more aggressive surgical approaches. Since wide resection margins cannot be achieved in all patients, application of intraoperative radiation therapy (IORT) has been frequently discussed. Still, the significance of IORT in multimodal treatment of retroperitoneal STS remains unclear.Material and methodsPatients undergoing resection of primary or recurrent retroperitoneal STS at the University of Heidelberg Department of General, Visceral and Transplantation Surgery were retrospectively analyzed. Univariate Kaplan-Meyer and multivariate Cox regression analyses were performed to identify predictors of LR-free survival and to investigate the impact of IORT and high cumulative radiation doses. Analyses with propensity-score matched subgroups for IORT and cumulative radiation dose were performed to control for selection bias. Subgroup analyses for patients with retroperitoneal liposarcoma were likewise performed.Results272 patients were identified. Recurrent tumors, histology of dedifferentiated liposarcoma or unclassified sarcoma and microscopically incomplete resection were associated with decreased LR-free survival. In liposarcoma, only recurrent and dedifferentiated tumors were confirmed as poor prognostic factors concerning LR. IORT and cumulative radiation doses exceeding 60 Gy did not influence LR rates (estimated 5-year LR-free survival: IORT: 39%, non-IORT: 46%; p = 0.79).ConclusionIn this retrospective evaluation, additional application of IORT does not significantly influence oncological outcome in retroperitoneal soft tissue sarcoma. Randomized trials are needed to clarify the benefit of IORT.
Keywords:Retroperitoneal soft tissue sarcoma  Surgery  IORT  Radiation therapy  Recurrence analysis  Survival analysis  soft tissue sarcoma  local recurrence  overall survival  external beam radiation therapy  intraoperative radiation therapy  cRD"}  {"#name":"keyword"  "$":{"id":"kwrd0095"}  "$$":[{"#name":"text"  "_":"cumulative radiation dose  dedifferentiated liposarcoma  well-differentiated liposarcoma  leiomyosarcoma  malignant peripheral nerve sheath tumor  intermediate malignancy: solitary fibrous tumor & desmoid fibromatosis
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