Neoadjuvant Radiation and Organ Sparing in Retroperitoneal Sarcoma

For surgical oncologists managing retroperitoneal sarcoma (RPS), the decision to utilize neoadjuvant radiation often hinges on the hope of downsizing tumors to facilitate organ-sparing resections. However, new data suggests that radiographic evidence of organ involvement may remain static despite preoperative therapy.

In a recent interview with CancerNetwork®, Emily Papai, MD, a PGY-3 surgery resident at Fox Chase Cancer Center, sat down to discuss the results of her study, "Radiographic response and its role in organ-sparing surgery for retroperitoneal sarcoma," published in the Journal of Surgical Research. Papai explored the shift in practice patterns toward more selective use of radiation and emphasized why these complex cases necessitate a nuanced, multidisciplinary approach to surgical planning.

Transcript:

It is up to the clinician. I can’t tell everyone what to do, and that’s what the NCCN guidelines are there for. Our practice at Fox Chase has been slowly leaning towards utilizing less neoadjuvant radiation, which is demonstrated in our data. We found that over half of the patients that we’ve treated in our inclusion-type criteria did not receive new adjuvant radiation, so we weren't able to comment on their response for this study. While our practice is leading away from it, it’s not something that I would tell a patient who received it that it was the wrong thing. Because ultimately, people are trying to do this to help in any way they can, especially when someone comes in with a very large tumor that may be involving other organs, there’s always this hope that maybe giving it some extra treatment will spare that person a nephrectomy, or spare that person an oophorectomy or something along those lines. If we could spare an entire organ, why not take the chance? That is a clinical discussion with the patient and with the multidisciplinary team that’s taking care of them. That does highlight the importance of having [patients] with something like RPS get treated by a multidisciplinary team, which is often most effectively coordinated at somewhere like a cancer center.