UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Clinical features, evaluation, and treatment of retroperitoneal soft tissue sarcoma

Authors
John T Mullen, MD, FACS
Thomas F DeLaney, MD
Section Editors
Robert Maki, MD, PhD
Russell S Berman, MD
Raphael E Pollock, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Sarcomas are malignant tumors that arise from skeletal and extraskeletal connective tissues, including the peripheral nervous system. The majority of soft tissue sarcomas (STS) present in the extremities; however, many other sites can be affected, including the retroperitoneum, chest wall, head and neck, and subcutaneous tissues.

The treatment of STS arising in the retroperitoneum will be reviewed here. A general discussion of the diagnostic evaluation and staging of STS, treatment of localized STS at other sites, local and systemic therapy for metastatic disease, treatment of desmoid tumors (which may present in intraabdominal and abdominal wall sites), and gastrointestinal stromal tumors (GIST; mesenchymal tumors that usually present in the wall of the gastrointestinal tract but occasionally present in extravisceral abdominal locations) are presented elsewhere:

(See "Clinical presentation, histopathology, diagnostic evaluation, and staging of soft tissue sarcoma", section on 'Introduction'.)

(See "Local treatment for primary soft tissue sarcoma of the extremities and chest wall".)

(See "Treatment of locally recurrent and unresectable, locally advanced soft tissue sarcoma of the extremities".)

                                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Wed Nov 16 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Lawrence W Jr, Donegan WL, Natarajan N, et al. Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons. Ann Surg 1987; 205:349.
  2. Raut CP, Pisters PW. Retroperitoneal sarcomas: Combined-modality treatment approaches. J Surg Oncol 2006; 94:81.
  3. Porter GA, Baxter NN, Pisters PW. Retroperitoneal sarcoma: a population-based analysis of epidemiology, surgery, and radiotherapy. Cancer 2006; 106:1610.
  4. Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001; 92:359.
  5. Gronchi A, Casali PG, Fiore M, et al. Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. Cancer 2004; 100:2448.
  6. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg 1998; 228:355.
  7. Liles JS, Tzeng CW, Short JJ, et al. Retroperitoneal and intra-abdominal sarcoma. Curr Probl Surg 2009; 46:445.
  8. Pham TH, Iqbal CW, Zarroug AE, et al. Retroperitoneal sarcomas in children: outcomes from an institution. J Pediatr Surg 2007; 42:829.
  9. Evans HL. Atypical lipomatous tumor, its variants, and its combined forms: a study of 61 cases, with a minimum follow-up of 10 years. Am J Surg Pathol 2007; 31:1.
  10. Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F. World Health Organization Classification of tumours of soft tissue and bone, 4th, IARC Press, Lyon 2013.
  11. Dei Tos AP, Pedeutour F. Atypical lipomatous tumour. In: World Health Organization Classification of tumours of soft tissue and bone, 4th, Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F.. (Eds), IARC, Lyon 2013. p.33.
  12. Perez EA, Gutierrez JC, Moffat FL Jr, et al. Retroperitoneal and truncal sarcomas: prognosis depends upon type not location. Ann Surg Oncol 2007; 14:1114.
  13. Nathan H, Raut CP, Thornton K, et al. Predictors of survival after resection of retroperitoneal sarcoma: a population-based analysis and critical appraisal of the AJCC staging system. Ann Surg 2009; 250:970.
  14. Chung L, Lau SK, Jiang Z, et al. Overlapping features between dedifferentiated liposarcoma and undifferentiated high-grade pleomorphic sarcoma. Am J Surg Pathol 2009; 33:1594.
  15. Hostein I, Pelmus M, Aurias A, et al. Evaluation of MDM2 and CDK4 amplification by real-time PCR on paraffin wax-embedded material: a potential tool for the diagnosis of atypical lipomatous tumours/well-differentiated liposarcomas. J Pathol 2004; 202:95.
  16. Lahat G, Tuvin D, Wei C, et al. New perspectives for staging and prognosis in soft tissue sarcoma. Ann Surg Oncol 2008; 15:2739.
  17. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg 2003; 238:358.
  18. Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg 1991; 214:2.
  19. Kilkenny JW 3rd, Bland KI, Copeland EM 3rd. Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg 1996; 182:329.
  20. Weiss SW, Rao VK. Well-differentiated liposarcoma (atypical lipoma) of deep soft tissue of the extremities, retroperitoneum, and miscellaneous sites. A follow-up study of 92 cases with analysis of the incidence of "dedifferentiation". Am J Surg Pathol 1992; 16:1051.
  21. Strauss G, Christensen L, Zapf J. Tumour-induced hypoglycaemia due to 'big' IGF-II. J Intern Med 1994; 236:97.
  22. Alldinger I, Yang Q, Pilarsky C, et al. Retroperitoneal soft tissue sarcomas: prognosis and treatment of primary and recurrent disease in 117 patients. Anticancer Res 2006; 26:1577.
  23. Jaques DP, Coit DG, Hajdu SI, Brennan MF. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg 1990; 212:51.
  24. Lahat G, Madewell JE, Anaya DA, et al. Computed tomography scan-driven selection of treatment for retroperitoneal liposarcoma histologic subtypes. Cancer 2009; 115:1081.
  25. Wilkinson MJ, Martin JL, Khan AA, et al. Percutaneous core needle biopsy in retroperitoneal sarcomas does not influence local recurrence or overall survival. Ann Surg Oncol 2015; 22:853.
  26. Pollock RE, Maki RG, Baldini EH, et al.. Soft Tissue Sarcoma of the Retroperitoneum. In: AJCC Cancer Staging Manual, 8th, Amin, MB. (Eds), AJCC, Chicago 2017. p.531.
  27. Singer S, Corson JM, Demetri GD, et al. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg 1995; 221:185.
  28. Heslin MJ, Lewis JJ, Nadler E, et al. Prognostic factors associated with long-term survival for retroperitoneal sarcoma: implications for management. J Clin Oncol 1997; 15:2832.
  29. van Dalen T, Hennipman A, Van Coevorden F, et al. Evaluation of a clinically applicable post-surgical classification system for primary retroperitoneal soft-tissue sarcoma. Ann Surg Oncol 2004; 11:483.
  30. Gronchi A, Miceli R, Shurell E, et al. 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; 31:1649.
  31. Toulmonde M, Bonvalot S, Méeus P, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 2014; 25:735.
  32. Hassan I, Park SZ, Donohue JH, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg 2004; 239:244.
  33. Catton CN, O'Sullivan B, Kotwall C, et al. Outcome and prognosis in retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 1994; 29:1005.
  34. Lehnert T, Cardona S, Hinz U, et al. Primary and locally recurrent retroperitoneal soft-tissue sarcoma: local control and survival. Eur J Surg Oncol 2009; 35:986.
  35. Anaya DA, Lev DC, Pollock RE. The role of surgical margin status in retroperitoneal sarcoma. J Surg Oncol 2008; 98:607.
  36. Pierie JP, Betensky RA, Choudry U, et al. Outcomes in a series of 103 retroperitoneal sarcomas. Eur J Surg Oncol 2006; 32:1235.
  37. Avancès C, Mottet N, Mahatmat A, et al. Prognostic factors for first recurrence in patients with retroperitoneal sarcoma. Urol Oncol 2006; 24:94.
  38. van Dalen T, Hoekstra HJ, van Geel AN, et al. Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients. Eur J Surg Oncol 2001; 27:564.
  39. Mendenhall WM, Zlotecki RA, Hochwald SN, et al. Retroperitoneal soft tissue sarcoma. Cancer 2005; 104:669.
  40. Russo P, Kim Y, Ravindran S, et al. Nephrectomy during operative management of retroperitoneal sarcoma. Ann Surg Oncol 1997; 4:421.
  41. Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol 2009; 27:24.
  42. Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol 2009; 27:31.
  43. Bonvalot S, Miceli R, Berselli M, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol 2010; 17:1507.
  44. Bonvalot S, Raut CP, Pollock RE, et al. Technical considerations in surgery for retroperitoneal sarcomas: position paper from E-Surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol 2012; 19:2981.
  45. Trans-Atlantic RPS Working Group. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol 2015; 22:256.
  46. Schwarzbach MH, Hormann Y, Hinz U, et al. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg 2006; 44:46.
  47. Daylami R, Amiri A, Goldsmith B, et al. Inferior vena cava leiomyosarcoma: is reconstruction necessary after resection? J Am Coll Surg 2010; 210:185.
  48. Hollenbeck ST, Grobmyer SR, Kent KC, Brennan MF. Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg 2003; 197:575.
  49. Fiore M, Colombo C, Locati P, et al. Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol 2012; 19:511.
  50. Shibata D, Lewis JJ, Leung DH, Brennan MF. Is there a role for incomplete resection in the management of retroperitoneal liposarcomas? J Am Coll Surg 2001; 193:373.
  51. Petersen IA, Haddock MG, Donohue JH, et al. Use of intraoperative electron beam radiotherapy in the management of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys 2002; 52:469.
  52. Willett CG, Suit HD, Tepper JE, et al. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer 1991; 68:278.
  53. Gunderson LL, Nagorney DM, McIlrath DC, et al. External beam and intraoperative electron irradiation for locally advanced soft tissue sarcomas. Int J Radiat Oncol Biol Phys 1993; 25:647.
  54. Krempien R, Roeder F, Oertel S, et al. Intraoperative electron-beam therapy for primary and recurrent retroperitoneal soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 2006; 65:773.
  55. Gieschen HL, Spiro IJ, Suit HD, et al. Long-term results of intraoperative electron beam radiotherapy for primary and recurrent retroperitoneal soft tissue sarcoma. Int J Radiat Oncol Biol Phys 2001; 50:127.
  56. Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg 1993; 128:402.
  57. Stojadinovic A, Leung DH, Hoos A, et al. Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 2002; 235:424.
  58. Zagars GK, Ballo MT, Pisters PW, et al. Surgical margins and reresection in the management of patients with soft tissue sarcoma using conservative surgery and radiation therapy. Cancer 2003; 97:2544.
  59. Delaney TF, Kepka L, Goldberg SI, et al. Radiation therapy for control of soft-tissue sarcomas resected with positive margins. Int J Radiat Oncol Biol Phys 2007; 67:1460.
  60. van Doorn RC, Gallee MP, Hart AA, et al. Resectable retroperitoneal soft tissue sarcomas. The effect of extent of resection and postoperative radiation therapy on local tumor control. Cancer 1994; 73:637.
  61. Jones JJ, Catton CN, O'Sullivan B, et al. Initial results of a trial of preoperative external-beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol 2002; 9:346.
  62. Choi AH, Barnholtz-Sloan JS, Kim JA. Effect of radiation therapy on survival in surgically resected retroperitoneal sarcoma: a propensity score-adjusted SEER analysis. Ann Oncol 2012; 23:2449.
  63. Nussbaum DP, Rushing CN, Lane WO, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 2016; 17:966.
  64. Nielsen OS, O'Sullivan B. Retroperitoneal soft tissue sarcomas: a treatment challenge and a call for randomized trials. Radiother Oncol 2002; 65:133.
  65. Tzeng CW, Fiveash JB, Popple RA, et al. Preoperative radiation therapy with selective dose escalation to the margin at risk for retroperitoneal sarcoma. Cancer 2006; 107:371.
  66. Ito H, Hornick JL, Bertagnolli MM, et al. Leiomyosarcoma of the inferior vena cava: survival after aggressive management. Ann Surg Oncol 2007; 14:3534.
  67. Ballo MT, Zagars GK, Pollock RE, et al. Retroperitoneal soft tissue sarcoma: an analysis of radiation and surgical treatment. Int J Radiat Oncol Biol Phys 2007; 67:158.
  68. Zlotecki RA, Katz TS, Morris CG, et al. Adjuvant radiation therapy for resectable retroperitoneal soft tissue sarcoma: the University of Florida experience. Am J Clin Oncol 2005; 28:310.
  69. Yoon SS, Chen YL, Kirsch DG, et al. Proton-beam, intensity-modulated, and/or intraoperative electron radiation therapy combined with aggressive anterior surgical resection for retroperitoneal sarcomas. Ann Surg Oncol 2010; 17:1515.
  70. Hull MA, Niemierko A, Haynes AB, et al. Improved local control with an aggressive strategy of preoperative with or without intraoperative radiation therapy combined with radical surgical resection for retroperitoneal sarcoma (abstract). Data presented at the annual Connective Tissue Oncology Society Annual Meeting, Berlin Germany, October 15-18, 2014.
  71. Kelly KJ, Yoon SS, Kuk D, et al. Comparison of Perioperative Radiation Therapy and Surgery Versus Surgery Alone in 204 Patients With Primary Retroperitoneal Sarcoma: A Retrospective 2-Institution Study. Ann Surg 2015; 262:156.
  72. Bremjit PJ, Jones RL, Chai X, et al. A contemporary large single-institution evaluation of resected retroperitoneal sarcoma. Ann Surg Oncol 2014; 21:2150.
  73. Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection, and intraoperative electron-beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol 2003; 21:3092.
  74. Pawlik TM, Pisters PW, Mikula L, et al. Long-term results of two prospective trials of preoperative external beam radiotherapy for localized intermediate- or high-grade retroperitoneal soft tissue sarcoma. Ann Surg Oncol 2006; 13:508.
  75. Cheng H, Miura JT, Lalehzari M, et al. Neoadjuvant radiotherapy for retroperitoneal sarcoma: A systematic review. J Surg Oncol 2016; 113:628.
  76. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31:1341.
  77. Bossi A, De Wever I, Van Limbergen E, Vanstraelen B. Intensity modulated radiation-therapy for preoperative posterior abdominal wall irradiation of retroperitoneal liposarcomas. Int J Radiat Oncol Biol Phys 2007; 67:164.
  78. Koshy M, Landry JC, Lawson JD, et al. Intensity modulated radiation therapy for retroperitoneal sarcoma: a case for dose escalation and organ at risk toxicity reduction. Sarcoma 2003; 7:137.
  79. Musat E, Kantor G, Caron J, et al. [Comparison of intensity-modulated postoperative radiotherapy with conventional postoperative conformal radiotherapy for retroperitoneal sarcoma]. Cancer Radiother 2004; 8:255.
  80. Baldini EH, Wang D, Haas RL, et al. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel. Int J Radiat Oncol Biol Phys 2015; 92:602.
  81. Baldini EH, Abrams RA, Bosch W, et al. Retroperitoneal Sarcoma Target Volume and Organ at Risk Contour Delineation Agreement Among NRG Sarcoma Radiation Oncologists. Int J Radiat Oncol Biol Phys 2015; 92:1053.
  82. Baldini EH, Bosch W, Kane JM 3rd, et al. Retroperitoneal sarcoma (RPS) high risk gross tumor volume boost (HR GTV boost) contour delineation agreement among NRG sarcoma radiation and surgical oncologists. Ann Surg Oncol 2015; 22:2846.
  83. Gronchi A, De Paoli A, Dani C, et al. Preoperative chemo-radiation therapy for localised retroperitoneal sarcoma: a phase I-II study from the Italian Sarcoma Group. Eur J Cancer 2014; 50:784.
  84. Eilber F, Eckardt J, Rosen G, et al. Preoperative therapy for soft tissue sarcoma. Hematol Oncol Clin North Am 1995; 9:817.
  85. Meric F, Hess KR, Varma DG, et al. Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas. Cancer 2002; 95:1120.
  86. Wendtner CM, Abdel-Rahman S, Krych M, et al. Response to neoadjuvant chemotherapy combined with regional hyperthermia predicts long-term survival for adult patients with retroperitoneal and visceral high-risk soft tissue sarcomas. J Clin Oncol 2002; 20:3156.
  87. Meric F, Milas M, Hunt KK, et al. Impact of neoadjuvant chemotherapy on postoperative morbidity in soft tissue sarcomas. J Clin Oncol 2000; 18:3378.
  88. Donahue TR, Kattan MW, Nelson SD, et al. Evaluation of neoadjuvant therapy and histopathologic response in primary, high-grade retroperitoneal sarcomas using the sarcoma nomogram. Cancer 2010; 116:3883.
  89. Issels RD, Lindner LH, Verweij J, et al. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 2010; 11:561.
  90. Pervaiz N, Colterjohn N, Farrokhyar F, et al. A systematic meta-analysis of randomized controlled trials of adjuvant chemotherapy for localized resectable soft-tissue sarcoma. Cancer 2008; 113:573.
  91. Le Cesne A, Ouali M, Leahy MG, et al. Doxorubicin-based adjuvant chemotherapy in soft tissue sarcoma: pooled analysis of two STBSG-EORTC phase III clinical trials. Ann Oncol 2014; 25:2425.
  92. Linehan DC, Lewis JJ, Leung D, Brennan MF. Influence of biologic factors and anatomic site in completely resected liposarcoma. J Clin Oncol 2000; 18:1637.
  93. Tan MC, Brennan MF, Kuk D, et al. Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma. Ann Surg 2016; 263:593.
  94. Toulmonde M, Le Cesne A, Mendiboure J, et al. Long-term recurrence of soft tissue sarcomas: prognostic factors and implications for prolonged follow-up. Cancer 2014; 120:3003.
  95. Karakousis CP, Velez AF, Gerstenbluth R, Driscoll DL. Resectability and survival in retroperitoneal sarcomas. Ann Surg Oncol 1996; 3:150.
  96. Alektiar KM, Hu K, Anderson L, et al. High-dose-rate intraoperative radiation therapy (HDR-IORT) for retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2000; 47:157.
  97. Paryani NN, Zlotecki RA, Swanson EL, et al. Multimodality local therapy for retroperitoneal sarcoma. Int J Radiat Oncol Biol Phys 2012; 82:1128.
  98. Jenkins MP, Alvaranga JC, Thomas JM. The management of retroperitoneal soft tissue sarcomas. Eur J Cancer 1996; 32A:622.
  99. Klooster B, Rajeev R, Chrabaszcz S, et al. Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)? J Surg Oncol 2016; 113:823.
  100. Herman K, Gruchała A, Niezabitowski A, et al. Prognostic factors in retroperitoneal sarcomas: ploidy of DNA as a predictor of clinical outcome. J Surg Oncol 1999; 71:32.
  101. Erzen D, Sencar M, Novak J. Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana. J Surg Oncol 2005; 91:1.
  102. Pacelli F, Tortorelli AP, Rosa F, et al. Retroperitoneal soft tissue sarcoma: prognostic factors and therapeutic approaches. Tumori 2008; 94:497.
  103. Ardoino I, Miceli R, Berselli M, et al. Histology-specific nomogram for primary retroperitoneal soft tissue sarcoma. Cancer 2010; 116:2429.
  104. Anaya DA, Lahat G, Wang X, et al. Establishing prognosis in retroperitoneal sarcoma: a new histology-based paradigm. Ann Surg Oncol 2009; 16:667.
  105. Anaya DA, Lahat G, Wang X, et al. Postoperative nomogram for survival of patients with retroperitoneal sarcoma treated with curative intent. Ann Oncol 2010; 21:397.
  106. Mussi C, Collini P, Miceli R, et al. The prognostic impact of dedifferentiation in retroperitoneal liposarcoma: a series of surgically treated patients at a single institution. Cancer 2008; 113:1657.
  107. Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002; 20:791.
  108. Dalal KM, Kattan MW, Antonescu CR, et al. Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg 2006; 244:381.
  109. Postoperative sarcoma nomogram http://nomograms.mskcc.org/Sarcoma/PostSurgery.aspx (Accessed on January 06, 2012).
  110. Raut CP, Miceli R, Strauss DC, et al. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer 2016; 122:1417.
  111. ESMO / European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 Suppl 7:vii92.
  112. Gyorki DE, Brennan MF. Management of recurrent retroperitoneal sarcoma. J Surg Oncol 2014; 109:53.
  113. Gronchi A, Strauss DC, Miceli R, et al. 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.
  114. Wang YN, Zhu WQ, Shen ZZ, et al. Treatment of locally recurrent soft tissue sarcomas of the retroperitoneum: report of 30 cases. J Surg Oncol 1994; 56:213.
  115. Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg 2003; 138:248.
  116. Zagars GK, Ballo MT, Pisters PW, et al. Prognostic factors for disease-specific survival after first relapse of soft-tissue sarcoma: analysis of 402 patients with disease relapse after initial conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 2003; 57:739.
  117. Chiappa A, Zbar AP, Bertani E, et al. Primary and recurrent retroperitoneal soft tissue sarcoma: prognostic factors affecting survival. J Surg Oncol 2006; 93:456.
  118. Park JO, Qin LX, Prete FP, et al. Predicting outcome by growth rate of locally recurrent retroperitoneal liposarcoma: the one centimeter per month rule. Ann Surg 2009; 250:977.
  119. Yeh JJ, Singer S, Brennan MF, Jaques DP. Effectiveness of palliative procedures for intra-abdominal sarcomas. Ann Surg Oncol 2005; 12:1084.
  120. Dziewirski W, Rutkowski P, Nowecki ZI, et al. Surgery combined with intraoperative brachytherapy in the treatment of retroperitoneal sarcomas. Ann Surg Oncol 2006; 13:245.
  121. Serizawa I, Kagei K, Kamada T, et al. Carbon ion radiotherapy for unresectable retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys 2009; 75:1105.