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Original article
peer-reviewed

Long-Term Quality of Life of Retroperitoneal Sarcoma Patients Treated with Pre-Operative Radiotherapy and Surgery



Abstract

Purpose: Retroperitoneal sarcomas (RPS) are connective tissue cancers that are often large and anatomically in close proximity to critical and radiation-sensitive normal structures and organs within the abdomen and pelvis. The management of RPS may include preoperative radiotherapy (RT) and surgery. We aimed to examine how treatment-related toxicities affect patient quality of life (QOL). 

Methods and materials: Within two prospective cohort studies, 48 RPS patients who were treated with preoperative RT from 1998-2012 were recruited and assessed for QOL (EORTC-QLQ-C30) and to determine toxicities potentially related to RT and surgery (graded using CTCAE V.4). Baseline and prospective QOL was available for 11 patients. In the other 37 patients, prospective data were obtained at different time points during their follow-up. Unless stated otherwise, all scores refer to the global QOL subscale.

Results: The patients' median age was 57 (38-82) and RT was administered to a median dose of 45 Gy (41.4-50.4). The median maximum tumor dimension was 16.0 cm (5.7-28) and the majority (35/48) were liposarcomas. The mean pre-RT QOL was 48.5/100. At one month post-RT, the mean QOL improved to 54.2; however, the mean diarrhea symptom scale worsened from baseline (78.3 vs. 18.2, p<0.001). Correspondingly, 54% of patients had gastrointestinal toxicities (92% G1-2 and 8% G3) by the end of RT. At 36 months post-RT, 88% of patients had chronic toxicities (19% G3). RPS patients who survived and are free of recurrence ≥ 36 months had significantly (mean: 75.0; p=0.001) better QOL than at diagnosis. The number of toxicities was significantly (p=0.001) associated with QOL. RT dose, tumor size, patient age, and patient gender were not associated with 36-month QOL. 

Conclusions: Treatment toxicities seem to contribute to QOL recovery during the first 36 months. QOL at 36 months was better than at diagnosis.



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Original article
peer-reviewed

Long-Term Quality of Life of Retroperitoneal Sarcoma Patients Treated with Pre-Operative Radiotherapy and Surgery


Author Information

Philip Wong Corresponding Author

Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)

Zahra Kassam

Radiation Oncology, Stronach Regional Cancer Center

Amanda N. Springer

Faculty of Science, Queen’s University

Rebecca Gladdy

Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre

Peter Chung

Radiation Oncology, University of Toronto

Jolie Ringash

Radiation Medicine Program, Princess Margaret Hospital/University Health Network

Charles Catton

Radiation Medicine Program, University of Toronto and Universitry Health Network


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. University Health Network issued approval 10-0854. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Philip wong declare(s) a grant from Elekta. Funding provided by CARO-Elekta fellowship grant. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Acknowledgements

This work was supported by the CARO-Elekta Research Fellowship.


Original article
peer-reviewed

Long-Term Quality of Life of Retroperitoneal Sarcoma Patients Treated with Pre-Operative Radiotherapy and Surgery


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Original article
peer-reviewed

Long-Term Quality of Life of Retroperitoneal Sarcoma Patients Treated with Pre-Operative Radiotherapy and Surgery

Philip Wong">Philip Wong , Zahra Kassam">Zahra Kassam, Amanda N. Springer">Amanda N. Springer, Rebecca Gladdy">Rebecca Gladdy, Peter Chung">Peter Chung, Jolie Ringash">Jolie Ringash, Charles Catton">Charles Catton

  • Author Information
    Philip Wong Corresponding Author

    Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)

    Zahra Kassam

    Radiation Oncology, Stronach Regional Cancer Center

    Amanda N. Springer

    Faculty of Science, Queen’s University

    Rebecca Gladdy

    Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre

    Peter Chung

    Radiation Oncology, University of Toronto

    Jolie Ringash

    Radiation Medicine Program, Princess Margaret Hospital/University Health Network

    Charles Catton

    Radiation Medicine Program, University of Toronto and Universitry Health Network


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. University Health Network issued approval 10-0854. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Philip wong declare(s) a grant from Elekta. Funding provided by CARO-Elekta fellowship grant. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements

    This work was supported by the CARO-Elekta Research Fellowship.


    Article Information

    Published: October 11, 2017

    DOI

    10.7759/cureus.1764

    Cite this article as:

    Wong P, Kassam Z, Springer A N, et al. (October 11, 2017) Long-Term Quality of Life of Retroperitoneal Sarcoma Patients Treated with Pre-Operative Radiotherapy and Surgery. Cureus 9(10): e1764. doi:10.7759/cureus.1764

    Publication history

    Received by Cureus: July 21, 2017
    Peer review began: August 16, 2017
    Peer review concluded: October 04, 2017
    Published: October 11, 2017

    Copyright

    © Copyright 2017
    Wong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose: Retroperitoneal sarcomas (RPS) are connective tissue cancers that are often large and anatomically in close proximity to critical and radiation-sensitive normal structures and organs within the abdomen and pelvis. The management of RPS may include preoperative radiotherapy (RT) and surgery. We aimed to examine how treatment-related toxicities affect patient quality of life (QOL). 

Methods and materials: Within two prospective cohort studies, 48 RPS patients who were treated with preoperative RT from 1998-2012 were recruited and assessed for QOL (EORTC-QLQ-C30) and to determine toxicities potentially related to RT and surgery (graded using CTCAE V.4). Baseline and prospective QOL was available for 11 patients. In the other 37 patients, prospective data were obtained at different time points during their follow-up. Unless stated otherwise, all scores refer to the global QOL subscale.

Results: The patients' median age was 57 (38-82) and RT was administered to a median dose of 45 Gy (41.4-50.4). The median maximum tumor dimension was 16.0 cm (5.7-28) and the majority (35/48) were liposarcomas. The mean pre-RT QOL was 48.5/100. At one month post-RT, the mean QOL improved to 54.2; however, the mean diarrhea symptom scale worsened from baseline (78.3 vs. 18.2, p<0.001). Correspondingly, 54% of patients had gastrointestinal toxicities (92% G1-2 and 8% G3) by the end of RT. At 36 months post-RT, 88% of patients had chronic toxicities (19% G3). RPS patients who survived and are free of recurrence ≥ 36 months had significantly (mean: 75.0; p=0.001) better QOL than at diagnosis. The number of toxicities was significantly (p=0.001) associated with QOL. RT dose, tumor size, patient age, and patient gender were not associated with 36-month QOL. 

Conclusions: Treatment toxicities seem to contribute to QOL recovery during the first 36 months. QOL at 36 months was better than at diagnosis.



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Philip Wong

Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)

For correspondence:
pwong.kf@gmail.com

Zahra Kassam

Radiation Oncology, Stronach Regional Cancer Center

Amanda N. Springer

Faculty of Science, Queen’s University

Rebecca Gladdy

Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre

Peter Chung

Radiation Oncology, University of Toronto

Jolie Ringash

Radiation Medicine Program, Princess Margaret Hospital/University Health Network

Charles Catton

Radiation Medicine Program, University of Toronto and Universitry Health Network

Philip Wong

Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)

For correspondence:
pwong.kf@gmail.com

Zahra Kassam

Radiation Oncology, Stronach Regional Cancer Center

Amanda N. Springer

Faculty of Science, Queen’s University

Rebecca Gladdy

Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre

Peter Chung

Radiation Oncology, University of Toronto

Jolie Ringash

Radiation Medicine Program, Princess Margaret Hospital/University Health Network

Charles Catton

Radiation Medicine Program, University of Toronto and Universitry Health Network