The role of radiation in retroperitoneal sarcomas: a surgical perspective.

PURPOSE OF REVIEW: This review focuses on the current concepts relating to the use of radiation therapy in the care of surgical patients with retroperitoneal sarcoma. Radiation therapy for retroperitoneal sarcoma patients is complex because it requires decisions on not only the timing of administration, but also the technique of delivery. RECENT STUDIES: Multiple studies have reported improved local recurrence-free survival in patients who received adjuvant external beam radiation therapy. Recent studies have demonstrated the efficacy of more sophisticated delivery methods for radiation therapy to deliver high dose rates while sparing surrounding normal tissues. Other recent studies have demonstrated the safety and feasibility of preoperative radiation therapy for retroperitoneal sarcoma. Preoperative radiation results in decreased local recurrence rates and minimal toxicity. The use of intraoperative radiation therapy has also been examined as a means to improve local recurrence rates, but may be associated with more radiation-related morbidity.
SUMMARY: There is good evidence that radiation therapy improves local control rates. Preoperative external beam radiation therapy may be the preferred sequence to improve tumor resectability and local-regional control with less risk of complications. Although data suggest that the addition of intraoperative radiation therapy to external beam radiation therapy improves local control, intraoperative radiation therapy may be related to additional toxicity.