Retroperitoneal sarcoma

[Kroll2013]

Dear friends, what is the best delay between the end of neoadjuvant RT and surgery in retroperitoneal sarcoma?

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[xrthopeful]

When you have a question like this, the best thing to do is do whatever the current open protocols are doing.

Look at EORTC 62092 or NCT01659203 protocols that are currently looking at neoadjuvant chemoRT for RP sarcoma

 

[Neuronix]

We do 4-6 week delay after RT in RP sarcoma. There's no data that I'm aware of--just a general consensus that it's the ideal time to have tumor response without fibrosis making surgery more difficult.

 

[seper]

well, since gross disease does not shrink, people usually just wait 4-6 weeks for acute mucositis to calm down.

 

[Neuronix]

It's a good point that radiographically the disease does not typically shrink with RT. Our sarcoma surgeons tell me that the capsule around the tumor tends to become more defined and easier to separate from critical structures (especially aorta, IVC) at that time period. Also, margins that they'd be concerned about without pre-op RT are much more likely to be negative with the pre-op RT.

We do a lot of neoadjuvant pancreas chemoRT, and our GI surgeons independently tell us the same thing with the SMV/SMA after neoadjuvant chemoRT. So I believe there's something to it.

Many of our patients basically have limited or zero side effects and could go to surgery sooner than 4-6 weeks. I'm not sure anyone is eager to try pushing it any sooner than 4 weeks for uncertain benefit.