A 65-year-old man with no significant past medical or surgical history who previously underwent an attempted but aborted resection of a left retroperitoneal DDLPS.
- Left colectomy was performed at that time
- Neoadjuvant systemic therapy had been discussed but upfront surgery was elected
- Postoperatively, Adriamycin (doxorubicin)/ifosfamide were initiated locally
- Patient presented to the institution for a second opinion. The patient reported that he also felt a “lump in the left flank/back”
- Physical exam: well-appearing thin man
- Abdominal exam: a palpable firm mass in the left abdomen
CT imaging
- A large left retroperitoneal tumor with indistinct borders and concern for extension to the abdominal wall
- Enhancing areas of the abdominal wall concerning for metastasis vs biopsy tract seeding
- No evidence of pulmonary lesions
Biopsy
- Biopsy of abdominal wall lesion confirmed additional sites of DDLPS
Prognosis: 7-year OS 23% and 7-year DFS 2%
Treatment
- Tumor resection with en bloc resection of portion of left diaphragm, left 11th/12th ribs, abdominal wall and plastics reconstruction.
Surveillance
Every 3 months and no evidence of disease for 1 year. Afterwards, developed site of biopsy-confirmed metastasis.
At this stage, what factors are taken into consideration when deciding the treatment plan?
What is the most commonly chosen treatment modality at this stage?
