Abstract
Retroperitoneal sarcomas (RPS) are rare malignancies that are potentially curable
by complete surgical resection. A regular surveillance program is normally commenced
following surgery due to the risk of local recurrence (LR), especially in low-intermediate
grade disease, and distant metastases (DM), especially in high-grade RPS. Consensus
guidelines usually advocate for more frequent imaging during the first 2–3 years and
less intensive imaging over a prolonged period thereafter, reflecting the incidence
pattern of LR and DM. Definitive evidence for the most effective imaging schedule
has never been provided, and retrospective studies have not shown an association between
follow-up intensity and survival. Improvement in the prediction of recurrence patterns
has been sustained by prognostic dynamic nomograms, which are now capable of forecasting
disease behaviour in each patient according to specific features. Incorporation of
such tools in clinical practice may help to stratify patients and tailor ongoing surveillance
to the risk of recurrence. This may help to relieve patients’ anxiety while awaiting
results of surveillance investigations, and also reduce the economic and environmental
burden of repeated imaging. A randomized controlled study (SARveillance Trial) is
proposed to shed light on this controversial topic, allowing clinicians to harmonize
the follow-up protocol of patients undergoing surgery for RPS.
Abbreviations:
RPS (retroperitoneal soft tissue sarcoma), LR (local recurrence), DM (distant metastasis), OS (overall survival), FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer), HR-QoL (health-related quality of life), ESMO (European Society for Medical Oncology), STS (soft tissue sarcoma), SAFETY (Surveillance AFter Extremity Tumoursurgery), CT (computed tomography), TOSS (Trial for Optimal Surveillance in Sarcomas), NCCN (National Comprehensive Cancer Network), TARPSWG (Transatlantic Australasian Retroperitoneal Sarcoma Working Group), EURCAN (European Reference Network for Rare Adult Solid Cancers), GENTURIS (European Reference Network for Genetic Tumour Risk Syndromes), MRI (magnetic resonance imaging), WDLPS (well-differentiated liposarcoma), DDLPS (de-differentiated liposarcoma), EORTC (European Organisation for Research and Treatment of Cancer), QLQ-C30 (Quality of life - Core questionnaire)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Surgical OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2018; 29: 51-67https://doi.org/10.1093/annonc/mdy096
- Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial.Lancet Oncol. 2020; 21: 1366-1377https://doi.org/10.1016/S1470-2045(20)30446-0
- UK guidelines for the management of soft tissue sarcomas.Clin Sarcoma Res. 2016; 6: 20https://doi.org/10.1186/s13569-016-0060-4
- Predictors of surgical quality for retroperitoneal sarcoma: volume matters.J Surg Oncol. 2017; 116: 766-774https://doi.org/10.1002/jso.24710
- Inoperable primary retroperitoneal sarcomas: clinical characteristics and reasons against resection at a single referral institution.Ann Surg Oncol. 2021 Feb; 28: 1151-1157https://doi.org/10.1245/s10434-020-08789-9
- Impact of centralization of services on outcomes in a rare tumour: retroperitoneal sarcomas.Eur J Surg Oncol. 2019; 45: 249-253https://doi.org/10.1016/j.ejso.2018.06.032
- Increased survival of non low-grade and deep-seated soft tissue sarcoma after surgical management in high-volume hospitals: a nationwide study from The Netherlands.Eur J Cancer. 2019; 110: 98-106https://doi.org/10.1016/j.ejca.2019.01.005
- 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.Ann Surg Oncol. 2021 Mar; 28: 1700-1709https://doi.org/10.1245/s10434-020-09065-6
- Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working group.Ann Surg. 2016; 263: 1002-1009https://doi.org/10.1097/SLA.0000000000001447
- Recurrence patterns after resection of retroperitoneal sarcomas: an eight-institution study from the US Sarcoma Collaborative.J Surg Oncol. 2019; 120: 340-347https://doi.org/10.1002/jso.25606
- The impact of postoperative radiological surveillance intensity on disease free and overall survival from primary retroperitoneal, abdominal and pelvic soft-tissue sarcoma.Eur J Surg Oncol. 2021; https://doi.org/10.1016/j.ejso.2021.01.021
- Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system.Int J Cancer. 1984; 33: 37-42https://doi.org/10.1002/ijc.2910330108
- Long-term follow-up and post-relapse outcome of patients with localized retroperitoneal sarcoma treated in the Italian sarcoma group-soft tissue sarcoma (ISG-STS) protocol 0303.Ann Surg Oncol. 2017; 24: 3872-3879https://doi.org/10.1245/s10434-017-6105-y
- The Surveillance after Extremity Tumor Surgery (SAFETY) trial: protocol for a pilot study to determine the feasibility of a multi-centre randomised controlled trial.BMJ Open. 2019 Sep 18; 9e029054https://doi.org/10.1136/bmjopen-2019-029054
- Does intensity of surveillance affect survival after surgery for sarcomas? Results of a randomized noninferiority trial.Clin Orthop Relat Res. 2014 May; 472: 1568-1575https://doi.org/10.1007/s11999-013-3385-9
- Surveillance strategies for sarcoma: results of a survey of members of the musculoskeletal tumor society.Sarcoma. 2016; 2016: 8289509https://doi.org/10.1155/2016/8289509
- Management of soft tissue sarcomas in extremities: variation in treatment recommendations and surveillance according to specialty and continent.Ann Surg Oncol. 2021 Nov; 28: 7923-7936https://doi.org/10.1245/s10434-021-09946-4
- Cost-effectiveness analysis of imaging surveillance in stage II and III extremity soft tissue sarcoma: an Australian perspective.Cost Eff Resour Allocation. 2020 Feb 3; 18: 5https://doi.org/10.1186/s12962-020-0202-7
- Cost-effectiveness of surveillance for distant recurrence in extremity soft tissue sarcoma.Ann Surg Oncol. 2017 Oct; 24: 3264-3270https://doi.org/10.1245/s10434-017-5996-y
- Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up.Ann Oncol. 2021 Nov; 32: 1348-1365https://doi.org/10.1016/j.annonc.2021.07.006
- Soft-tissue sarcoma in adults: an update on the current state of histiotype-specific management in an era of personalized medicine.Ca - Cancer J Clin. 2020; 70: 200-229https://doi.org/10.3322/caac.21605
- What is the role of routine follow-up for localised limb soft tissue sarcomas? A retrospective analysis of 174 patients.Br J Cancer. 2014; 110: 2420-2426https://doi.org/10.1038/bjc.2014.200
- NCCN guidelines version 2.Soft Tissue Sarcoma. 2021;
- Management of primary retroperitoneal sarcoma (RPS) in the adult: an updated consensus approach from the transatlantic australasian RPS working group.Ann Surg Oncol. 2021; 28: 7873-7888https://doi.org/10.1245/s10434-021-09654-z
- Long-term morbidity after multivisceral resection for retroperitoneal sarcoma.Br J Surg. 2015 Aug; 102: 1079-1087https://doi.org/10.1002/bjs.9829
- Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: a study and novel nomogram from TARPSWG.Clin Cancer Res. 2019 Apr 15; 25: 2664-2671https://doi.org/10.1158/1078-0432.CCR-18-2700
- Patterns of recurrence and survival probability after second recurrence of retroperitoneal sarcoma: a study from TARPSWG.Cancer. 2020 Nov 15; 126: 4917-4925https://doi.org/10.1002/cncr.33139
- Risk stratification of patients undergoing pulmonary metastasectomy for soft tissue and bone sarcomas.J Thorac Cardiovasc Surg. 2015 Jan; 149: 85-92https://doi.org/10.1016/j.jtcvs.2014.09.039
- Outcomes and clinical predictors of improved survival in a patients undergoing pulmonary metastasectomy for sarcoma.J Surg Oncol. 2015 Jul; 112: 103-106https://doi.org/10.1002/jso.23961
- Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy.Eur J Surg Oncol. 2009 Apr; 35: 356-361https://doi.org/10.1016/j.ejso.2008.01.004
- Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma.J Thorac Cardiovasc Surg. 2017 Jul; 154: 319-330.e1https://doi.org/10.1016/j.jtcvs.2017.02.061
- Risks of first and subsequent cancers among TP53 mutation carriers in the National Cancer Institute Li-Fraumeni syndrome cohort.Cancer. 2016 Dec 1; 122: 3673-3681https://doi.org/10.1002/cncr.30248
- Biochemical and imaging surveillance in germline TP53 mutation carriers with Li-Fraumeni syndrome: a prospective observational study.Lancet Oncol. 2011 Jun; 12: 559-567https://doi.org/10.1016/S1470-2045(11)70119-X
- Guidelines for the Li-Fraumeni and heritable TP53-related cancer syndromes.Eur J Hum Genet. 2020 Oct; 28: 1379-1386https://doi.org/10.1038/s41431-020-0638-4
- Revisiting Li-Fraumeni syndrome from TP53 mutation carriers.J Clin Oncol. 2015 Jul 20; 33: 2345-2352https://doi.org/10.1200/JCO.2014.59.5728
- Guidelines for the diagnosis and management of individuals with neurofibromatosis 1.J Med Genet. 2007 Feb; 44: 81-88https://doi.org/10.1136/jmg.2006.045906
- Malignant peripheral nerve sheath tumours in neurofibromatosis 1.J Med Genet. 2002 May; 39: 311-314https://doi.org/10.1136/jmg.39.5.311
- Whole body MRI committee for the REiNS international collaboration; REiNS International Collaboration Members 2016. Current whole-body MRI applications in the neurofibromatoses: NF1, NF2, and schwannomatosis.Neurology. 2016 Aug 16; 87: S31-S39https://doi.org/10.1212/WNL.0000000000002929
- Current status and recommendations for imaging in neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis.Skeletal Radiol. 2020 Feb; 49: 199-219https://doi.org/10.1007/s00256-019-03290-1
- The role of [18F]FDG-PET/CT in predicting malignant transformation of plexiform neurofibromas in neurofibromatosis-1.Int J Surg Oncol. 2016; 2016: 6162182https://doi.org/10.1155/2016/6162182
- International consensus statement on malignant peripheral nerve sheath tumors in neurofibromatosis.Cancer Res. 2002 Mar 1; 62 (PMID: 11894862): 1573-1577
- Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets.J Clin Oncol. 2013 May 1; 31: 1649-1655https://doi.org/10.1200/JCO.2012.44.3747
- Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma.Ann Surg. 2016 Mar; 263: 593-600https://doi.org/10.1097/SLA.0000000000001149
- Prognosis for primary retroperitoneal sarcoma survivors: a conditional survival analysis.Cancer. 2012 Jul 1; 118: 3321-3329https://doi.org/10.1002/cncr.26665
- Longitudinal prognostication in retroperitoneal sarcoma survivors: development and external validation of two dynamic nomograms.Eur J Cancer. 2021 Nov; 157: 291-300https://doi.org/10.1016/j.ejca.2021.08.008
- Evaluating the impact of surveillance follow-up intervals in patients following resection of primary well-differentiated liposarcoma of the retroperitoneum.Ann Surg Oncol. 2021; 28: 570-575
- Salvage surgery for recurrent retroperitoneal well-differentiated liposarcoma: early reoperation may not provide benefit.Ann Surg Oncol. 2018 Aug; 25: 2193-2200https://doi.org/10.1245/s10434-018-6417-6
- A prospective observational study of multivisceral resection for retroperitoneal sarcoma: clinical and patient-reported outcomes 1 Year after surgery.Ann Surg Oncol. 2021 Jul; 28: 3904-3916https://doi.org/10.1245/s10434-020-09307-7
- We're on a merry-go-round": reflections of patients and carers after completing treatment for sarcoma.Curr Oncol. 2021 Aug 6; 28: 3003-3014https://doi.org/10.3390/curroncol28040263
- Follow-up strategies following completion of primary cancer treatment in adult cancer survivors.Cochrane Database Syst Rev. 2019; 2019https://doi.org/10.1002/14651858.CD012425.pub2
- Scan-associated distress in lung cancer: quantifying the impact of "scanxiety.Lung Cancer. 2016; 100: 110-113https://doi.org/10.1016/j.lungcan.2016.08.002
Article info
Publication history
Published online: March 03, 2022
Accepted:
February 14,
2022
Received:
January 18,
2022
Identification
Copyright
© 2022 Published by Elsevier Ltd.
