Retroperitoneal Sarcoma Care in 2021

Abstract

Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.

Keywords: radiation therapy; retroperitoneal sarcoma; sarcoma; soft-tissue tumor; systemic therapy.

Figure 1

Schematic representation of the retroperitoneal perinephric compartments. ARF anterior renal fascia, PRF posterior renal fascia, TF transversalis fascia, APS anterior pararenal space, PPS posterior pararenal space, PS pararenal space, V vena cava, A abdominal aorta, D duodenum, AC ascending colon, DC descending colon, P pancreas, PC peritoneal cavity.

Figure 2

Diagram representation of the common subtypes of sarcoma within the retroperitoneum: DDLPS dedifferentiated liposarcoma; WDLPS well-differentiated liposarcoma, LMS leiomyosarcoma; US undifferentiated sarcoma; SFT solitary fibrous tumor, MPNST malignant peripheral nerve sheath, FS fibrosarcoma [9].