TY - JOUR
T1 - Radiation Therapy for Retroperitoneal Sarcomas
T2 - Influences of Histology, Grade, and Size
AU - Leiting, Jennifer L.
AU - Bergquist, John R.
AU - Hernandez, Matthew C.
AU - Merrell, Kenneth W.
AU - Folpe, Andrew L.
AU - Robinson, Steven I.
AU - Nagorney, David M.
AU - Truty, Mark J.
AU - Grotz, Travis E.
N1 - Funding Information:
-e NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. -e data used are derived from a dei-dentified NCDB participant user file. -e American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methods or the conclusions drawn from these data by the investigators. -e authors gratefully acknowledge the support of the Department of Surgery and the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic as substantial contributors of resources to the project.
Publisher Copyright:
© 2018 Jennifer L. Leiting et al.
PY - 2018
Y1 - 2018
N2 - Perioperative radiation therapy (RT) has been associated with reduced local recurrence in patients with retroperitoneal sarcomas (RPS); however, selection criteria remain unclear. We hypothesized that perioperative RT would improve survival in patients with RPS and would be associated with pathological factors. The National Cancer Database (NCDB) from 2004 to 2012 was reviewed for patients with nonmetastatic RPS undergoing curative intent resection. Tumor size was dichotomized at 15 cm based on 8th edition American Joint Committee on Cancer (AJCC) staging. Patients with the highest comorbidity score were excluded. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards modeling analyzed overall survival (OS). Multivariable logistic regression modeled margin positivity. A total of 2,264 patients were included; 727 patients (32.1%) had perioperative radiation in whom 203 (9.0%) had radiation preoperatively. Median (IQR) RPS size was 17.5 [11.0-27.0] cm. Histopathology was high grade in 1048 patients (43.7%). Multivariable analysis revealed that perioperative radiation was independently associated with decreased mortality (HR 0.72, 95% confidence intervals (CIs) 0.62-0.84, p<0.001), and preoperative RT was associated with reduced margin positivity (HR 0.72, 95% CI 0.53-0.97, p=0.032). Stratified survival analysis showed that radiation was associated with prolonged median OS for RPS that were high-grade (64.3 vs. 43.6 months, p<0.001), less than 15 cm (104.1 vs. 84.2 months, p=0.007), and leiomyosarcomatous (104.8 vs. 61.8 months, p<0.001). Perioperative radiation is independently associated with decreased mortality in patients with high-grade, less than 15 cm, and leiomyosarcomatous tumors. Preoperative radiation is independently associated with margin-negative resection. These data support the selective use of perioperative radiation in the multidisciplinary management of RPS.
AB - Perioperative radiation therapy (RT) has been associated with reduced local recurrence in patients with retroperitoneal sarcomas (RPS); however, selection criteria remain unclear. We hypothesized that perioperative RT would improve survival in patients with RPS and would be associated with pathological factors. The National Cancer Database (NCDB) from 2004 to 2012 was reviewed for patients with nonmetastatic RPS undergoing curative intent resection. Tumor size was dichotomized at 15 cm based on 8th edition American Joint Committee on Cancer (AJCC) staging. Patients with the highest comorbidity score were excluded. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards modeling analyzed overall survival (OS). Multivariable logistic regression modeled margin positivity. A total of 2,264 patients were included; 727 patients (32.1%) had perioperative radiation in whom 203 (9.0%) had radiation preoperatively. Median (IQR) RPS size was 17.5 [11.0-27.0] cm. Histopathology was high grade in 1048 patients (43.7%). Multivariable analysis revealed that perioperative radiation was independently associated with decreased mortality (HR 0.72, 95% confidence intervals (CIs) 0.62-0.84, p<0.001), and preoperative RT was associated with reduced margin positivity (HR 0.72, 95% CI 0.53-0.97, p=0.032). Stratified survival analysis showed that radiation was associated with prolonged median OS for RPS that were high-grade (64.3 vs. 43.6 months, p<0.001), less than 15 cm (104.1 vs. 84.2 months, p=0.007), and leiomyosarcomatous (104.8 vs. 61.8 months, p<0.001). Perioperative radiation is independently associated with decreased mortality in patients with high-grade, less than 15 cm, and leiomyosarcomatous tumors. Preoperative radiation is independently associated with margin-negative resection. These data support the selective use of perioperative radiation in the multidisciplinary management of RPS.
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U2 - 10.1155/2018/7972389
DO - 10.1155/2018/7972389
M3 - Article
AN - SCOPUS:85058950753
SN - 1357-714X
VL - 2018
JO - Sarcoma
JF - Sarcoma
M1 - 7972389
ER -