The efficacy of preoperative radiotherapy combined with surgery versus surgery alone for primary retroperitoneal sarcoma has been analyzed. A recent meta-analysis of 13 studies involving over 3,800 patients provides new insights.
The analysis, which included data from 2,439 patients who underwent surgery alone and 1,453 who received preoperative radiotherapy followed by surgery, revealed significant findings. The combination of preoperative radiotherapy (preRT) and surgery led to lower local recurrence (LR) rates, with hazard ratios indicating improved outcomes for specific patient subgroups.
Notably, for patients diagnosed with well-differentiated liposarcoma and low-grade dedifferentiated liposarcoma, preRT + surgery significantly extended abdominal recurrence-free survival (ARFS). This highlights the potential benefits of radiation therapy, especially for these less aggressive histological types.
Interestingly, the study found no marked difference in overall survival (OS) between the two groups, indicating the complexity of treatment outcomes. Instead, patients receiving preRT + S experienced higher rates of both total and severe complications, raising questions about the balance between potential benefits and risks.
Existing guidelines for treating retroperitoneal sarcoma primarily advocate for surgical resection, yet the role of radiotherapy has remained understudied. Despite advancements, the meta-analysis reaffirms the challenges of ensuring negative margins during surgical interventions, which are common due to the tumor's location and surrounding structures.
While the evidence collected indicates preRT can provide some local control for specific patient subgroups, it also necessitates careful consideration of treatment-related complications. The findings urge clinicians to tailor treatments appropriately, ensuring they weigh the advantages of potentially improving local control against the risk of increased complications and the lack of impact on overall survival.
The study opens avenues for future research directed at identifying which patient populations might benefit most from preRT, potentially refining treatment pathways to optimize therapeutic outcomes.