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

Abstract

Purpose: The management of retroperitoneal sarcomas (RPS) may include pre-operative radiotherapy (RT) and surgery. As RPS often require multi-visceral resection, combined treatment of RPS can be associated with substantial toxicity as radiation sensitive organs may be affected by pre-op RT. We aimed to examine how these treatments related toxicities affect patient quality of life (QOL). Methods and Materials: In a cross-sectional study, 25 primary RPS patients treated with pre-operative IMRT from 2004-2012 were recruited and assessed for QOL (EORTC QLQ-C30) and to determine RT and surgery related toxicities (CTCAE V.4). Baseline and prospective QOL was available for 11 patients. In the other 14 patients cross-sectional data alone were obtained at different time points during their follow up (four weeks, six months, one year, three years, five years and 10 years post- IMRT). Unless stated otherwise, all scores refer to the global domain. Results: Ten female and 15 male patients with a median age of 56 (38-80) were treated with IMRT to a median dose of 50.4 Gy (41.4-50.4). The median maximum dimension was 13.4 cm (5.7- 28) and the majority (17/25) were liposarcomas. The median time from completion of RT to RPS surgery was 9.4 weeks (5- 17.4). Of the 11 patients who completed baseline QOL assessments, their compliance at four weeks, six months, one year and three years post-RT were 80%, 100%, 90%, and 100%. Mean pre-RT QOL was 48.5 (standard deviation (SD) 19.3). At four weeks post-RT, mean QOL was 57.5 (SD: 23.7) however, the mean diarrhea symptom scale increased from baseline (85 versus 18.1, p < 0.001). Correspondingly, 54% of patients had gastrointestinal toxicities (32% G1, 56% G2 and 8% G3) by the end of RT. Regression slope analysis suggested that QOL significantly (p = 0.002) improved over the first three years. The number of toxicities was significantly (p = 0.002) associated with QOL over time. Clinically important improvement (> 10 points) from baseline was observed at one year (68.6, SD: 18.4). At three years post-RT, 88% of patients had chronic RT and/or surgery related toxicities of which 30% were Grade 3 toxicities. RPS patients who survived at least three years had significantly better QOL (mean: 67.2, p = 0.007 Mann-Whitney Test) relative to the full group at diagnosis. QOL changed little (mean: 0.31 point/month; SD: 0.36) after three years (n = 10). RT dose, tumour size, patient age and gender were not associated with three year QOL scores. Conclusions: Treatment toxicities seem to contribute to QOL recovery during the first three years. The number of toxicities a patient had was significantly associated with QOL. Despite patients having on average 2.5 treatment-related chronic toxicities, QOL at three years was better than at diagnosis.