Review

. 2022 Nov;29(12):7335-7348.

doi: 10.1245/s10434-022-11864-y. Epub 2022 Jun 29.

Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

William W Tseng¹, Carol J Swallow², Dirk C Strauss³, Sylvie Bonvalot⁴, Piotr Rutkowski⁵, Samuel J Ford⁶, Ricardo J Gonzalez⁷, Rebecca A Gladdy⁸, David E Gyorki⁹, Mark Fairweather¹⁰, Kyo Won Lee¹¹, Markus Albertsmeier¹², Winan J van Houdt¹³, Magalie Fau¹⁴, Carolyn Nessim¹⁵, Giovanni Grignani¹⁶, Kenneth Cardona¹⁷, Vittorio Quagliuolo¹⁸, Valerie Grignol¹⁹, Jeffrey M Farma²⁰, Elisabetta Pennacchioli²¹, Marco Fiore²², Andrew Hayes³, Dimitri Tzanis⁴, Jacek Skoczylas⁵, Max L Almond⁶, John E Mullinax⁷, Wendy Johnston⁸, Hayden Snow⁹, Rick L Haas^{23

24}, Dario Callegaro²², Myles J Smith^{3

25}, Toufik Bouhadiba⁴, Anant Desai⁶, Rachel Voss⁷, Roberta Sanfilippo^{26

27}, Robin L Jones^{25

28}, Elizabeth H Baldini²⁹, Andrew J Wagner³⁰, Charles N Catton³¹, Silvia Stacchiotti^{26

27}, Khin Thway³², Christina L Roland³³, Chandrajit P Raut¹⁰, Alessandro Gronchi³⁴; Transatlantic Australasian Retroperitoneal Sarcoma Working Group

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. tsengwill@yahoo.com.
² Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada. carol.swallow@sinaihealth.ca.
³ Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.
⁴ Department of Surgical Oncology, Institut Curie, PSL University, Paris, France.
⁵ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁶ Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK.
⁷ Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
⁸ Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada.
⁹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹⁰ Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA.
¹¹ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹² Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität Munich, University Hospital, Munich, Germany.
¹³ Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
¹⁴ , Bourdeaux, France.
¹⁵ Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁶ Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy.
¹⁷ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
¹⁸ Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
¹⁹ Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
²⁰ Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
²¹ Division of Melanoma, Sarcoma and Rare Tumor Surgery, European Institute of Oncology, Milan, Italy.
²² Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²³ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
²⁴ Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands.
²⁵ The Institute of Cancer Research, Chester Beatty Laboratories, London, UK.
²⁶ Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁷ Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁸ Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK.
²⁹ Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA.
³⁰ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³¹ Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
³² Sarcoma Unit, Department of Pathology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.
³³ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³⁴ Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. alessandro.gronchi@istitutotumori.mi.it.

PMID: 35767103
DOI: 10.1245/s10434-022-11864-y

Review

Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

William W Tseng et al. Ann Surg Oncol. 2022 Nov.

. 2022 Nov;29(12):7335-7348.

doi: 10.1245/s10434-022-11864-y. Epub 2022 Jun 29.

Authors

Affiliations

¹ Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA. tsengwill@yahoo.com.
² Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada. carol.swallow@sinaihealth.ca.
³ Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.
⁴ Department of Surgical Oncology, Institut Curie, PSL University, Paris, France.
⁵ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁶ Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK.
⁷ Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
⁸ Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada.
⁹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
¹⁰ Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA.
¹¹ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹² Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität Munich, University Hospital, Munich, Germany.
¹³ Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
¹⁴ , Bourdeaux, France.
¹⁵ Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁶ Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Torino, Italy.
¹⁷ Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
¹⁸ Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
¹⁹ Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
²⁰ Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
²¹ Division of Melanoma, Sarcoma and Rare Tumor Surgery, European Institute of Oncology, Milan, Italy.
²² Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²³ Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
²⁴ Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands.
²⁵ The Institute of Cancer Research, Chester Beatty Laboratories, London, UK.
²⁶ Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁷ Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁸ Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK.
²⁹ Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA.
³⁰ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
³¹ Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
³² Sarcoma Unit, Department of Pathology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK.
³³ Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³⁴ Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. alessandro.gronchi@istitutotumori.mi.it.

PMID: 35767103
DOI: 10.1245/s10434-022-11864-y

Abstract

Background: Surgery is the mainstay of treatment for retroperitoneal sarcoma (RPS), but local recurrence is common. Biologic behavior and recurrence patterns differ significantly among histologic types of RPS, with implications for management. The Transatlantic Australasian RPS Working Group (TARPSWG) published a consensus approach to primary RPS, and to complement this, one for recurrent RPS in 2016. Since then, additional studies have been published, and collaborative discussion is ongoing to address the clinical challenges of local recurrence in RPS.

Methods: An extensive literature search was performed, and the previous consensus statements for recurrent RPS were updated after review by TARPSWG members. The search included the most common RPS histologic types: liposarcoma, leiomyosarcoma, solitary fibrous tumor, undifferentiated pleomorphic sarcoma, and malignant peripheral nerve sheath tumor.

Results: Recurrent RPS management was evaluated from diagnosis to follow-up evaluation. For appropriately selected patients, resection is safe. Nomograms currently are available to help predict outcome after resection. These and other new findings have been combined with expert recommendations to provide 36 statements, each of which is attributed a level of evidence and grade of recommendation. In this updated document, more emphasis is placed on histologic type and clarification of the intent for surgical treatment, either curative or palliative. Overall, the fundamental tenet of optimal care for patients with recurrent RPS remains individualized treatment after multidisciplinary discussion by an experienced team with expertise in RPS.

Conclusions: Updated consensus recommendations are provided to help guide decision-making for treatment of locally recurrent RPS and better selection of patients who would potentially benefit from surgery.

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Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

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Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

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