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Surgery Combined With Intraoperative Brachytherapy in the Treatment of Retroperitoneal Sarcomas

Wirginiusz Dziewirski, MD¹, Piotr Rutkowski, MD¹, Zbigniew I. Nowecki, MD¹, Maciej Saamacha¹, Tadeusz Morysiski, MD¹, Anna Kulik, MD², Maria Kawczyska, PhD², Anetta Kasprowicz, MD², Jarosaw yczek, MD² and Wodzimierz Ruka, MD¹

¹ Department of Soft Tissue/Bone Sarcoma, M. Sklodowska-Curie Cancer Center and Institute of Oncology, W.K. Roentgena Str. 5, 02-781, Warsaw, Poland
² Department of Brachytherapy, M. Sklodowska-Curie Cancer Center and Institute of Oncology, W.K. Roentgena Str. 5, 02-781, Warsaw, Poland

Correspondence: Address correspondence and reprint requests to: Piotr Rutkowski, MD; E-mail: rutkowskip{at}coi.waw.pl.

Background: The purpose of this study was to analyze the results of treatment of retro-peritoneal soft tissue sarcomas (RSTS) by surgery combined with intraoperative brachytherapy (IOBRT).

Methods: Seventy adult patients with RSTS were considered for combined treatment (surgery plus IOBRT) between June 1998 and February 2004. There were 64 (91%) recurrent tumors, and 93% of tumors exceeded 5 cm. IOBRT was performed with high-dose-rate Gammamed 12 with iridium 192 (IOBRT time range, 20–87 minutes; median, 56 minutes).

Results: After intraoperative re-evaluation, 24 patients (34%) were found to be ineligible for IOBRT because of multiple intraperitoneal recurrences, macroscopically nonradical resection, poor general condition, and technical aspects. Thirty-seven patients underwent IOBRT immediately after surgery during the same general anesthesia procedure. Nine patients underwent delayed IOBRT within 1 to 3 days after the primary operation. Ten (21.5%) of 46 patients underwent reoperation because of surgical complications. One patient died in the postoperative period. After IOBRT, 24 patients (52%) underwent adjuvant external beam radiotherapy (EBRT) to a total dose of 50 Gy. Over a median follow-up time of 20 months, the estimated 5-year overall survival and local recurrence–free survival rates in IOBRT patients were 55% and 51%, respectively. Application of adjuvant EBRT showed a favorable local control rate.

Conclusions: The scheduled combined treatment (surgery plus IOBRT) was possible to perform in 66% of RSTS cases that received surgical treatment. The complication rate was high, but we consider it acceptable because of the necessity for extensive aggressive surgical treatment in regionally advanced RSTS. EBRT seems to be an indispensable part of treatment that provides better local control.

Key Words: Sarcoma • Retroperitoneal • Soft tissue • Recurrence • Brachytherapy • Radiotherapy