[Role of radiotherapy in the treatment of retroperitoneal soft tissue sarcomas]

Soft tissue sarcomas are rare tumors, composing 1% of all malignancies. Fifteen percent of them are situated in the retroperitoneal region. The primary curative treatment for this group of patients is complete surgical resection. In most cases, due to their large size and localization at diagnoses, complete resection (R0) is not feasible. The main cause of disease-specific death is local recurrence. Therefore, improved local control by radiotherapy (RT) may contribute to better survival results. Based on international studies, despite the frequent positive surgical margins, only 25% of the patients with retroperitoneal sarcoma (RPS) receive perioperative RT. We performed a literature review based on the available data on the role of RT in the management of RPS. The 5-year local recurrence-free survival after surgery alone, and surgery + RT has been reported in the range of 23-54% and 40-62%, respectively. The respective 5-year rate of overall survival was of 33-49% and 48-64%. There are no available results from prospective randomized studies comparing surgery to surgery + RT. The majority of studies were retrospective and the treatments were performed over a time span of several decades. The total dose, technique and timing of RT were not standardized. Gastrointestinal and genitourinary side effects of RT are common, but their incidence and severity can be significantly reduced by using modern techniques. Based on the currently available studies, RT improves local control and it may play a role in the prolongation of overall survival as well. However, prospective randomized studies are needed to clarify the role of RT in the multidisciplinary management of RPS.