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

Anna Lawless; Deborah Di-Xin Zhou; Joshua McDonough; Helen Lo; Jasmine Mar; Smaro Lazarakis; Iain Ward; Joanna Connor; Stephen R Thompson; David Coker; Andrew Johnston; David E Gyorki; Angela M Hong

doi:10.1016/j.ctrv.2023.102620

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

Cancer Treat Rev. 2023 Nov:120:102620. doi: 10.1016/j.ctrv.2023.102620. Epub 2023 Aug 28.

Authors

Anna Lawless¹, Deborah Di-Xin Zhou², Joshua McDonough³, Helen Lo⁴, Jasmine Mar⁵, Smaro Lazarakis⁶, Iain Ward⁷, Joanna Connor⁸, Stephen R Thompson⁹, David Coker¹⁰, Andrew Johnston¹¹, David E Gyorki¹², Angela M Hong¹³

Affiliations

¹ Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
² NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
³ Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia.
⁴ Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
⁵ Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia.
⁶ Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia.
⁷ Christchurch Hospital, Christchurch 8011, New Zealand.
⁸ Te Pūriri o Te Ora, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
⁹ Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Clinical Medicine, UNSW Sydney, Randwick Clinical Campus, Australia.
¹⁰ Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
¹¹ North Island Sarcoma Service, Auckland City Hospital, Auckland 1023, New Zealand.
¹² Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia.
¹³ Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia. Electronic address: angela.hong@sydney.edu.au.

PMID: 37657126
DOI: 10.1016/j.ctrv.2023.102620

Abstract

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.

Keywords: Liposarcoma; Radiotherapy; Retroperitoneal sarcoma; Sarcoma.

Publication types

Review