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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

  • Sarcoma
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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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Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    William W. Tseng MD

  2. Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, and Department of Surgery, University of Toronto, Toronto, Canada

    Carol J. Swallow MD, PhD, Rebecca A. Gladdy MD, PhD & Wendy Johnston PhD

  3. Sarcoma Unit, Department of Surgery, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK

    Dirk C. Strauss MD, Andrew Hayes MA, PhD & Myles J. Smith MB, BCh, BAO, PhD

  4. Department of Surgical Oncology, Institut Curie, PSL University, Paris, France

    Sylvie Bonvalot MD, PhD, Dimitri Tzanis MD, PhD & Toufik Bouhadiba MD

  5. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

    Piotr Rutkowski MD, PhD & Jacek Skoczylas MD

  6. Sarcoma Unit, Queen Elizabeth Hospital, Birmingham, UK

    Samuel J. Ford FRCS, PhD, Max L. Almond DM & Anant Desai MA, MD

  7. Sarcoma Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Ricardo J. Gonzalez MD, John E. Mullinax MD & Rachel Voss MD, MPH

  8. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia

    David E. Gyorki MBBS, MD & Hayden Snow MBBS

  9. Department of Surgery, Brigham and Women’s Hospital, Dana Farber Cancer Institute, Boston, MA, USA

    Mark Fairweather MD & Chandrajit P. Raut MD, MSc

  10. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Kyo Won Lee MD

  11. Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität Munich, University Hospital, Munich, Germany

    Markus Albertsmeier MD

  12. Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Winan J. van Houdt MD, PhD

  13. Bourdeaux, France

    Magalie Fau MD

  14. Department of Surgery, The Ottawa Hospital, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

    Carolyn Nessim MD, MSc

  15. Division of Medical Oncology, Candiolo Cancer Institute, FPO–IRCCS, Torino, Italy

    Giovanni Grignani MD

  16. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Kenneth Cardona MD

  17. Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy

    Vittorio Quagliuolo MD

  18. Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Valerie Grignol MD

  19. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Jeffrey M. Farma MD

  20. Division of Melanoma, Sarcoma and Rare Tumor Surgery, European Institute of Oncology, Milan, Italy

    Elisabetta Pennacchioli MD

  21. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Marco Fiore MD, Dario Callegaro MD & Alessandro Gronchi MD

  22. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Rick L. Haas MD, PhD

  23. Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands

    Rick L. Haas MD, PhD

  24. The Institute of Cancer Research, Chester Beatty Laboratories, London, UK

    Myles J. Smith MB, BCh, BAO, PhD & Robin L. Jones BSc, MBBS, MD (Res)

  25. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Roberta Sanfilippo MD & Silvia Stacchiotti MD

  26. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Roberta Sanfilippo MD & Silvia Stacchiotti MD

  27. Department of Medical Oncology, Royal Marsden NHS Foundation Trust, London, UK

    Robin L. Jones BSc, MBBS, MD (Res)

  28. Department of Radiation Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA, USA

    Elizabeth H. Baldini MD,MPH

  29. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    Andrew J. Wagner MD, PhD

  30. Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada

    Charles N. Catton MD

  31. Sarcoma Unit, Department of Pathology, Royal Marsden Hospital, Royal Marsden NHS Foundation Trust, London, UK

    Khin Thway MD, FRCPath

  32. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Christina L. Roland MD, MS

Authors
  1. William W. Tseng MD
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  2. Carol J. Swallow MD, PhD
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  3. Dirk C. Strauss MD
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  4. Sylvie Bonvalot MD, PhD
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  5. Piotr Rutkowski MD, PhD
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  6. Samuel J. Ford FRCS, PhD
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  7. Ricardo J. Gonzalez MD
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  8. Rebecca A. Gladdy MD, PhD
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  9. David E. Gyorki MBBS, MD
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  10. Mark Fairweather MD
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  11. Kyo Won Lee MD
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  12. Markus Albertsmeier MD
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  13. Winan J. van Houdt MD, PhD
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  14. Magalie Fau MD
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  15. Carolyn Nessim MD, MSc
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  16. Giovanni Grignani MD
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  17. Kenneth Cardona MD
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  18. Vittorio Quagliuolo MD
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  19. Valerie Grignol MD
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  21. Elisabetta Pennacchioli MD
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  22. Marco Fiore MD
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  30. Rick L. Haas MD, PhD
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  32. Myles J. Smith MB, BCh, BAO, PhD
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  33. Toufik Bouhadiba MD
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  34. Anant Desai MA, MD
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  35. Rachel Voss MD, MPH
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  36. Roberta Sanfilippo MD
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  37. Robin L. Jones BSc, MBBS, MD (Res)
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  38. Elizabeth H. Baldini MD,MPH
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  39. Andrew J. Wagner MD, PhD
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  40. Charles N. Catton MD
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  41. Silvia Stacchiotti MD
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  42. Khin Thway MD, FRCPath
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  43. Christina L. Roland MD, MS
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  44. Chandrajit P. Raut MD, MSc
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  45. Alessandro Gronchi MD
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Consortia

the Transatlantic Australasian Retroperitoneal Sarcoma Working Group

Corresponding authors

Correspondence to William W. Tseng MD, Carol J. Swallow MD, PhD or Alessandro Gronchi MD.

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Disclosure

These authors disclose the following financial relationships: Piotr Rutkowski: honoraria for lectures and Advisory Boards from BMS, MSD, Novartis, Pierre Fabre, Sanofi, Merck, Blueprint Medicines and Philogen outside of the scope of this article; David Gyorki: Speaker bureau – BMS, Novartis, Advisory Board – Amgen, Bayer, Q Biotics. Provectus; Silvia Stacchiotti: Institutional research funding from Amgen Dompe, Advenchen, Bayer, Blueprint Medicines, Deciphera, Eli Lilly, Epizyme, Daiichi Sankyo Pharma, GSK, Karyopharm, Novartis, Pfizer, PharmaMar, SpringWorks, and Hutchinson MediPharma International Inc; honoraria from Aadi, Bayer, Deciphera, Daiichi, Novartis, Pharmamar; fees for expert testimony from Bavarian Nordic and Epizyme; and participation on Advisory Board for Bayer, Deciphera, Eli Lilly, Daiichi, Ikena, Maxivax, Novartis, Rain Therapeutics, Pharmamar outside the submitted work. Christina Roland: Research Funds – Bristol Myers Squibb. All other authors have nothing to report.

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Tseng, W.W., Swallow, C.J., Strauss, D.C. et al. Management of Locally Recurrent Retroperitoneal Sarcoma in the Adult: An Updated Consensus Approach from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group. Ann Surg Oncol 29, 7335–7348 (2022). https://doi.org/10.1245/s10434-022-11864-y

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  • DOI: https://doi.org/10.1245/s10434-022-11864-y

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