4.6 Review

Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies

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Article Oncology

Histology-tailored multidisciplinary management of primary retroperitoneal sarcomas

S. Bonvalot et al.

Summary: Until recently, the recommended approach for primary retroperitoneal sarcomas (RPS) was complete en-bloc gross excision, with (neo) adjuvant treatments as optional and unvalidated by randomized studies, leading to variations in practice among different centers. However, recent studies on surgery and adjuvant treatments have provided insights to refine these recommendations. This review aims to summarize the recent advancements and future directions in RPS management.
Article Surgery

Preoperative Radiotherapy in Patients With Primary Retroperitoneal Sarcoma EORTC-62092 Trial (STRASS) Versus Off-trial (STREXIT) Results

Dario Callegaro et al.

Summary: The objective of this study was to compare the effect of radiotherapy (RT) on abdominal recurrence-free survival (ARFS) in patients with primary retroperitoneal sarcoma treated in two different cohorts and to test the hypothesis that RT improves ARFS in patients with liposarcoma. The study found that RT was associated with better ARFS in patients with primary well-differentiated liposarcoma.

ANNALS OF SURGERY (2023)

Article Oncology

Organ Infiltration and Patient Risk After Multivisceral Surgery for Primary Retroperitoneal Liposarcomas

Luca Improta et al.

Summary: This study investigated the impact of histological organ involvement (HOI) on the prognosis of primary retroperitoneal liposarcoma. Initial and advanced HOIs were frequently detected in both well-differentiated and de-differentiated liposarcomas, suggesting the need for multivisceral resection. HOI stratifies the risk of patients with primary retroperitoneal liposarcoma.

ANNALS OF SURGICAL ONCOLOGY (2023)

Article Oncology

Significant Predictors of Postoperative Morbidity After Radical Resection of Retroperitoneal Sarcoma in a Tertiary Center

Claudia Di Prata et al.

Summary: A retrospective study on the adverse events of patients undergoing multivisceral resection surgery for retroperitoneal sarcoma reveals that male gender, performance status, dedifferentiated liposarcoma histology, and low serum albumin level are significant predictors of major complications. Transfusion requirement is the only significant factor in predicting operative risk. Postoperative adverse events have no impact on overall survival or local recurrence.

ANNALS OF SURGICAL ONCOLOGY (2023)

Article Oncology

Clinical Impact of External Beam Radiotherapy for Surgically Resected Primary Retroperitoneal Liposarcoma

Derek J. Erstad et al.

Summary: This study investigated the real-world use and outcomes of radiotherapy for the management of retroperitoneal liposarcoma and found that it was not associated with improved overall survival in patients who underwent surgical resection.

ANNALS OF SURGICAL ONCOLOGY (2023)

Article Oncology

The role of standard and novel radiotherapy approaches in management of retroperitoneal sarcomas

L. M. Wiltink et al.

Summary: Primary non-metastatic retroperitoneal soft tissue sarcoma patients can be cured by radical surgery, but there is a risk of local recurrence. Preoperative radiotherapy may benefit patients with low grade liposarcomas. This review summarizes all issues related to the irradiation of patients with retroperitoneal soft tissue sarcoma.
Article Chemistry, Multidisciplinary

Metabolic Intervention Liposome Boosted Lung Cancer Radio-Immunotherapy via Hypoxia Amelioration and PD-L1 Restraint

Saijun Wang et al.

Summary: Currently, the limited success of radiotherapy in clinical practice is attributed to reduced DNA damage under hypoxia and acquired immune tolerance due to increased expression of PD-L1. This study demonstrates that intracellular PD-L1 depression can sensitize radiotherapy by inhibiting DNA damage repair. However, the effectiveness of radio-immunotherapy is still limited by the inability of clinically used antibodies to disrupt extracellular PD-L1 function. Therefore, better PD-L1 regulation strategies are urgently needed. The synthesis of TPP-LND and its encapsulation in liposomes can sensitize radiotherapy by reversing the hypoxic tumor microenvironment and reducing PD-L1 expression.

ADVANCED SCIENCE (2023)

Review Oncology

The Landscape of Immunotherapy for Retroperitoneal Sarcoma

Alicia A. Gingrich et al.

Summary: Significant efforts have been made to understand soft tissue sarcomas, including retroperitoneal sarcomas (RPS), which currently lack effective therapies. This review focuses on the relationship between immunotherapy and RPS histologic subtypes. Initial outcomes with immune checkpoint inhibition alone have been disappointing, but subsequent analyses have provided insight into the interplay between sarcomas and immunotherapy, identifying potential targets for future trials. With this insight, combination treatments tailored to the molecular characteristics of RPS show promise for improving response rates and outcomes.

CURRENT ONCOLOGY (2023)

Article Oncology

Neoadjuvant chemotherapy in high-risk soft tissue sarcomas: A Sarculator-based risk stratification analysis of the ISG-STS 1001 randomized trial

Sandro Pasquali et al.

Summary: The study investigated the benefit of neoadjuvant chemotherapy in soft tissue sarcoma patients based on prognostic stratification using the Sarculator nomogram. It found that high-risk patients treated with AI performed better than predicted, supporting the efficacy of neoadjuvant AI in STS.

CANCER (2022)

Article Oncology

Critical impact of radiotherapy protocol compliance and quality in the treatment of retroperitoneal sarcomas: Results from the EORTC 62092-22092 STRASS trial

Rick Haas et al.

Summary: This study investigates the impact of radiotherapy compliance on survival outcomes in patients with retroperitoneal sarcoma, showing that patients who complied with radiotherapy requirements had a significantly higher abdominal recurrence-free survival rate.

CANCER (2022)

Review Radiology, Nuclear Medicine & Medical Imaging

Improving the synergistic combination of programmed death-1/programmed death ligand-1 blockade and radiotherapy by targeting the hypoxic tumour microenvironment

Faiqa Mudassar et al.

Summary: The combination of PD-1/PD-L1 blockade and radiotherapy has the potential to enhance anti-tumour immunity and improve clinical outcomes, but tumour hypoxia presents a significant challenge to the success of both therapies. Targeting tumour hypoxia with compounds that reduce hypoxia may optimize the efficacy of the combination.

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY (2022)

Review Oncology

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.

Summary: This article summarizes the treatment consensus for locally recurrent retroperitoneal sarcoma (RPS). Resection surgery is found to be safe in appropriately selected patients, and combined with new findings and expert recommendations, 36 evidence-based and recommended statements are provided. The updated document emphasizes the histologic type and intention of surgical treatment. The fundamental principle for optimal care of patients with recurrent RPS remains individualized treatment after multidisciplinary discussion by an experienced team.

ANNALS OF SURGICAL ONCOLOGY (2022)

Article Oncology

Final Safety and Health-Related Quality of LIfe Results of the Phase 2/3 Act.In.Sarc Study With Preoperative NBTXR3 Plus Radiation Therapy Versus Radiation Therapy in Locally Advanced Soft-Tissue Sarcoma

Sylvie Bonvalot et al.

Summary: The study Act.In.Sarc demonstrated that NBTXR3, a first-in-class radioenhancer, activated by preoperative radiation therapy, can improve the pathologic complete response rate and achieve R0 resections in patients with locally advanced soft tissue sarcoma. The study also showed that NBTXR3 does not negatively impact health-related quality of life and safety.

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS (2022)

Article Oncology

Soft Tissue Sarcoma, Version 2.2022

Margaret von Mehren et al.

Summary: Soft tissue sarcomas (STS) are rare malignancies with diverse clinical and pathological characteristics. The diagnosis and treatment of STS require a multidisciplinary team. The NCCN Clinical Practice Guidelines provide comprehensive recommendations for the management of STS, including diagnosis, evaluation, and treatment.

JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK (2022)

Article Chemistry, Multidisciplinary

Tumor Selective Metabolic Reprogramming as a Prospective PD-L1 Depression Strategy to Reactivate Immunotherapy

Yu Liu et al.

Summary: In this study, a new PD-L1 regulation strategy was developed by selectively down-regulating PD-L1 expression in tumors using mitochondria-targeted IR-LND@Alb nanoparticles. The anti-tumor efficacy of this strategy was found to be superior to conventional anti-PD-L1 monoclonal antibodies. Interestingly, IR-LND also showed potential as a novel photodynamic therapy (PDT) drug with self-oxygen and self-PD-L1 regulation capability.

ADVANCED MATERIALS (2022)

Review Oncology

Landmark Series: A Review of Landmark Studies in the Treatment of Primary Localized Retroperitoneal Sarcoma

Megan Delisle et al.

Summary: Primary localized retroperitoneal soft tissue sarcomas have shorter survival due to higher local recurrence rates, large tumor size, and anatomical constraints. The curative treatment is macroscopic en bloc resection with adjacent structures. Preoperative radiotherapy has not proven effective in reducing early local recurrences. Observational studies suggest that systemic therapy may benefit patients with high-grade histologies and borderline resectable tumors. Ongoing trials are evaluating histology-tailored chemotherapy for high-risk leiomyosarcoma and dedifferentiated liposarcoma. Biomarkers may help predict prognosis and treatment response.

ANNALS OF SURGICAL ONCOLOGY (2022)

Article Oncology

Inoperable Primary Retroperitoneal Sarcomas: Clinical Characteristics and Reasons Against Resection at a Single Referral Institution

Andraz Perhavec et al.

Summary: The study analyzed a series of primary localized RPS patients at a large referral center and found that roughly 10% of patients were not suitable for surgical resection, with some having technically unresectable tumors and others having comorbidities/poor performance status.

ANNALS OF SURGICAL ONCOLOGY (2021)

Article Oncology

Has the Outcome for Patients Who Undergo Resection of Primary Retroperitoneal Sarcoma Changed Over Time? A Study of Time Trends During the Past 15 years

Dario Callegaro et al.

Summary: The long-term survival of patients who underwent resection for primary RPS has improved over the past 15 years, attributed to better patient selection for resection, quality of surgery, and perioperative patient management, as indicated by the study data.

ANNALS OF SURGICAL ONCOLOGY (2021)

Article Oncology

Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG)

Carolyn Nessim et al.

Summary: This study evaluated perioperative morbidity after surgery for first locally recurrent retroperitoneal sarcoma, showing that a surgical approach to recurrent RPS is relatively safe and resection of recurrent RPS is a reasonable option. Efforts should be made to minimize the need for blood transfusions.

ANNALS OF SURGICAL ONCOLOGY (2021)

Article Oncology

Defining the role of neoadjuvant systemic therapy in high-risk retroperitoneal sarcoma: A multi - institutional study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

William W. Tseng et al.

Summary: In high-risk RPS patients, the response to neoadjuvant systemic therapy is generally fair. Disease progression during therapy may be a predictor of survival post-surgery. Subtype-specific regimens should be further validated.

CANCER (2021)

Article Oncology

Management of Primary Retroperitoneal Sarcoma (RPS) in the Adult: An Updated Consensus Approach from the Transatlantic Australasian RPS Working Group

Carol J. Swallow et al.

Summary: Primary retroperitoneal sarcomas are rare and complex malignancies that are best managed by experienced multidisciplinary teams in specialized referral centers. Individualized management plans based on consensus statements should be made, and participation in prospective trials and studies is encouraged to improve outcomes.

ANNALS OF SURGICAL ONCOLOGY (2021)

Article Radiology, Nuclear Medicine & Medical Imaging

Multiexponential T2 relaxometry of benign and malignant adipocytic tumours

Katerina Nikiforaki et al.

EUROPEAN RADIOLOGY EXPERIMENTAL (2020)

Article Oncology

Hospital Volume Threshold for the Treatment of Retroperitoneal Sarcoma

Mohamed Abdelgadir Adam et al.

ANTICANCER RESEARCH (2019)

Article Radiology, Nuclear Medicine & Medical Imaging

T2, T2*and spin coupling ratio as biomarkers for the study of lipomatous tumors

Katerina Nikiforaki et al.

PHYSICA MEDICA-EUROPEAN JOURNAL OF MEDICAL PHYSICS (2019)

Review Oncology

Radiation therapy in retroperitoneal sarcoma management

Rick L. Haas et al.

JOURNAL OF SURGICAL ONCOLOGY (2018)

Review Oncology

Major vascular resections in retroperitoneal sarcoma

Dimitri Tzanis et al.

JOURNAL OF SURGICAL ONCOLOGY (2018)

Article Surgery

Long-term morbidity after multivisceral resection for retroperitoneal sarcoma

D. Callegaro et al.

BRITISH JOURNAL OF SURGERY (2015)

Review Oncology

Management of Recurrent Retroperitoneal Sarcoma

David E. Gyorki et al.

JOURNAL OF SURGICAL ONCOLOGY (2014)

Article Surgery

Major Blood Vessel Reconstruction During Sarcoma Surgery

Tae K. Song et al.

ARCHIVES OF SURGERY (2009)

Article Oncology

Why Do Patients with Low-Grade Soft Tissue Sarcoma Die?

Robert J. Canter et al.

ANNALS OF SURGICAL ONCOLOGY (2008)

Article Surgery

Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry

Juan C. Gutierrez et al.

JOURNAL OF SURGICAL RESEARCH (2007)

Article Surgery

Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement

Matthias H. M. Schwarzbach et al.

JOURNAL OF VASCULAR SURGERY (2006)