Outcomes of preoperative radiotherapy and resection of retroperitoneal sarcoma

Background Preoperative radiotherapy (RT) is an important component of the management of retroperitoneal sarcoma ( RPS ). We aimed to establish the feasibility of this approach by determining the accuracy of computed tomography ( CT )‐guided core biopsy, proportion of patients completing treatment, rates of acute toxicity and surgical complications, and treatment outcomes. Methods This is a retrospective review. Consecutive patients presenting between J anuary 1999 and D ecember 2009 with a diagnosis of either primary or recurrent RPS were identified. Those patients suitable for preoperative RT and surgery were included. Exclusions included presence of metastatic disease, age under 18 years and/or paediatric histology, and treatment with palliative intent. Results Twenty‐four patients were included, 14 were males. Median age was 61.4 years. Twenty‐three patients had Stage T2b , high‐grade disease. Twenty patients were treated at initial presentation and four at first local recurrence. Five‐year progression‐free survival, overall survival and local recurrence rates were 48.9, 53.7 and 22%, respectively. A malignant diagnosis was confirmed in all patients who underwent CT ‐guided core biopsy; a diagnosis of sarcoma was reached in 90%, histological subtype correctly identified in 66%. All patients in the cohort completed preoperative RT. Grade 3 toxicity occurred in 4% of patients ( n = 1). Seventy‐five per cent ( n = 18) proceeded to radical resection, where complete macroscopic excision was achieved in all cases. There was no perioperative mortality. Conclusion Preoperative RT has low levels of Grades 3 or 4 toxicity, and does not adversely impact surgical management. CT ‐guided core biopsy is an accurate means of confirming a diagnosis of RPS prior to definitive treatment.