Survival Benefit Reported With Radiotherapy vs Surgery Alone in Retroperitoneal Sarcoma

Key Points

  • Radiotherapy was associated with improved overall survival compared with surgery alone when delivered either preoperatively or postoperatively in patients with retroperitoneal sarcoma.
  • This is reportedly the largest study to date of the effect of radiotherapy on overall survival in patients with retroperitoneal sarcoma.

In a study using National Cancer Data Base data reported in The Lancet Oncology, Nussbaum et al found that preoperative and postoperative radiotherapy improved overall survival vs surgery alone in patients with retroperitoneal sarcoma.

Study Details

The study consisted of case-control, propensity score–matched analyses of data from adult patients with localized primary retroperitoneal sarcoma diagnosed from 2003 to 2011. Of a total of 9,068 patients, 563 were included in a preoperative radiotherapy group, 2,215 were in the postoperative radiotherapy group, and 6,290 were in the no radiotherapy group. Among these patients, comparisons were made between a 2:1 matched dataset of 1,126 no-radiotherapy patients and 563 preoperative-radiotherapy patients and a 1:1 matched data set of 2,196 no-radiotherapy patients and 2,196 postoperative-radiotherapy patients.

Survival Benefit

In the matched case-control analysis for preoperative radiotherapy, median follow-up was 42 months in the preoperative radiotherapy group and 43 months in the no radiotherapy group. Median overall survival was 110 months (95% confidence interval [CI] = 75 months to not estimable) vs 66 months (95% CI = 61–76 months). The hazard ratio (HR) was 0.70 (P < .0001).

In the matched case-control analysis for postoperative radiotherapy, median follow-up was 54 months for the postoperative-radiotherapy group and 47 months for the no-radiotherapy group. Median overall survival was 89 months (95% CI = 79–100 months) vs 64 months (95% CI = 59–69 months). The hazard ratio was 0.78 (P < .0001).

The investigators concluded: “To the best of our knowledge, this is the largest study to date of the effect of radiotherapy on overall survival in patients with retroperitoneal sarcoma. Radiotherapy was associated with improved overall survival compared with surgery alone when delivered as either preoperative radiotherapy or postoperative radiotherapy. Together with the results from the ongoing randomised EORTC trial (62092-22092; NCT01344018) investigating preoperative radiotherapy for retroperitoneal sarcoma, these data might provide additional support for the increasing use of radiotherapy for patients with retroperitoneal sarcoma undergoing surgical resection.”

The study was funded by Duke University School of Medicine.

Daniel P Nussbaum, MD, of Duke University Medical Center, is the corresponding author of The Lancet Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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