Treat local.

Retroperitoneal sarcomas are notorious for local recurrence. Here’s an interesting look at how patients do after their, not first, but second local recurrence. Because that’s what happened to 70% of patients (n=400) after resection of a first recurrence in this multi-institutional Australian database. When in isolation (i.e., no evidence of distant disease), most patients underwent a re-re-resection. In the setting of a local-only recurrence (81%, mostly liposarcoma), survival rate at 5 years was 45% versus <25% if distant mets present (the remaining 19%, mostly leiomyosarcoma). As expected, the biggest determinants of longer survival were longer treatment interval before second recurrence and ability to resect second recurrence. Unexpectedly (to us), only 14% of patients had a history of radiation even after a second recurrence. TBL: Patients with multiply-locally recurrent retroperitoneal sarcoma can live a long time, and there’s room to incorporate pre-op radiation into earlier treatment algorithms. | Houdt, Cancer 2020