Preoperative radiotherapy combined with surgery versus surgery alone for primary retroperitoneal sarcoma: a meta-analysis

Figures

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  Fig. 1. Flow diagram of the search strategy for study selection.

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  Fig. 2. Forest plots comparing risk of local recurrence between preoperative radiotherapy combined with surgery (preRT + S) and surgery alone. PreRT + S was associated with a significantly lower hazard ratio (HR) in retroperitoneal sarcoma but not in liposarcoma. When the patients with dedifferentiated liposarcoma (DDLPS) in the study by Chouliaras et al.26 were excluded from the liposarcoma group, the preRT + S group had a significantly low HR for local recurrence.

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  Fig. 3. Forest plots of risk of abdominal recurrence-free survival (ARFS). The hazard ratio (HR) of ARFS was comparable between all patients with retroperitoneal sarcoma and the liposarcoma subgroup who received preoperative radiotherapy. The HR of ARFS decreased significantly in the subgroup of patients with dedifferentiated liposarcoma (DDLPS) in the study by Chouliaras et al.26 and patients with well-differentiated liposarcoma and grade 1–2 dedifferentiated liposarcoma (WDLPS and G1–2DDLPS).

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  Fig. 4. Forest plots comparing the incidence of complications. In comparison with the surgery alone (SA) group, the group that received preoperative radiotherapy combined with surgery (preRT + S) had a significantly higher odds ratio for all, grade 4–5 (life-threatening or death), and grade 3 (severe) complications.

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  Fig. 5. Forest plots for overall survival outcomes reveal no significant difference after preoperative radiotherapy (preRT) in retroperitoneal sarcoma, liposarcoma, and well-differentiated liposarcoma and grade 1–2 dedifferentiated liposarcoma (WDLPS and G1–2DDLPS).