Treatment of Retroperitoneal Liposarcoma

Retroperitoneal liposarcoma is a distinct clinical scenario requiring careful pathological assessment before treatment planning. The balance between well-differentiated and dedifferentiated components of the tumour is a critical factor in surgical decision-making.

Clinical scenario: Primary retroperitoneal liposarcoma. Specific appreciation of the well-differentiated versus the dedifferentiated component(s) is critical to surgical decision-making in this setting.

Treatment overview

Surgery is the standard of care for primary retroperitoneal liposarcoma, with complete macroscopic resection as a single en bloc specimen forming the cornerstone of management. In certain grade-defined subgroups, a preoperative treatment approach may additionally be considered — though candidacy depends on histological features and this option is not applicable universally. The complete decision framework, including all criteria and sequencing steps, is available in the full protocol.

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References

DOI: 10.1016/j.annonc.2021.07.006

Specific appreciation of the well-differentiated versus the dedifferentiated component(s) of liposarcoma is critical to surgical decision making.

The standard treatment of primary lesions is surgery. This is best done by resecting the tumour en bloc with adherent structures [III, A]. Standard treatment of RPS consists of surgical resection en bloc with adherent organs [V, A]. Therefore, in patients with a low-intermediate grade liposarcoma preoperative RT can be discussed. Neoadjuvant RT has shown signs of efficacy in primary low-/intermediate-grade retroperitoneal liposarcoma [II, B]. On the contrary, no effect was seen in resectable LMS and high-grade dedifferentiated liposarcoma.

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