Management strategies following recurrence of resected retroperitoneal sarcoma: A 10-year observational study

Abstract

Background

In management of retroperitoneal sarcoma (RPS), radical resection remains the main facet of curative treatment. While recurrence is common, a clear consensus does not exist around optimal post-operative surveillance and post recurrence management.

Materials and methods

Patients undergoing resection for RPS over a 10 year period were identified through a prospectively maintained database. Patients underwent surveillance imaging with intensity dependant on risk of disease recurrence. Rates of recurrence, post recurrence therapeutic modalities and outcomes were recorded.

Results

105 patients underwent primary resection of RPS in the study period. 5-year survival of patients with low-risk and high-risk of disease recurrence was 74 % and 49 % respectively. Of the 58 patients that suffered disease recurrence, 29 patients with primary recurrence underwent further surgery, 10 patients with oligo-metastatic disease underwent curative intent management and 12 patients underwent chemotherapy (median survival: 6.5 vs 4.0 vs 1.7 years, 5-year survival: 71 % vs 45 % vs 12 %). The cost of surveillance imaging to identify recurrence treated with curative intent was calculated at £5434 and £2269 for low- and high-risk disease respectively.

Conclusions

Post resectional surveillance detects recurrence, allowing further intervention. Such strategies include surgical re-resection, interventional ablation or ablative radiotherapy of oligometastatic disease, and palliative chemotherapy; multifaceted therapeutic options which sit within current management guidelines. Patients with local recurrence who underwent further resection and those who underwent curative-intent management for other metastatic disease had improved outcomes compared to patients with widespread disease recurrence who underwent systemic chemotherapy. The costs of surveillance imaging fit within current UK healthcare economic policy guidelines.