The Role of Surgery in Oligometastatic Retroperitoneal Sarcoma

Round 1

Reviewer 1 Report

This is a very nice, very well-written review/overview of the use of surgery in the management of oligometastatic retroperitoneal sarcomas. It is very balanced and will be a very useful reference.

The only very minor comment that I'd have is that I think that the potential role of radiotherapy is understated in this era of stereotactic body radiotherapy and hypofractionation. It may be useful to add this since even if a specialist multidisciplinary team would be aware, others and trainees in surgery or other specialty programs may not.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

This is an extremely important and well-written review of metastatic disease in sarcomas. This is a difficult topic to tackle due to the heterogeneity of sarcomas, even within RPS. 

 

1) I think with radiation, it's important to note the subgroup analysis from the STRASS trial showing (unpowered) questionable benefit in low grade liposarcoma. In these patients where local recurrence can become a problem, doing an radiation (if being considered) while the bowel is pushed out of the way, may be beneficial v adjuvantly. 

2) While CRS/HIPEC has historically shown limited utility in most patients, with improved systemic therapies, there will be an evolving role of surgery. A recent publication from the French Sarcoma Group (I have no ties to them) suggests that surgery can improve OS. 

Author Response

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Reviewer 3 Report

The tools to improve outcomes for pattients with oligometastatic sarcoma have indeed improved. This review is primarily about the role of surgery. I like how the paper discusses need for multi-disciplinary efforts and clincal trial participation  to advance the field.  The reference list is extensive and additonal therapy options (chemotherapy, radiation and RFA) are mentioned; perhaps also cryoablation and SBRT as additoinal tools to help im management of these complex cases would cpomplete the list .  Specific sub trypes of sarcomas may be more amenable to current clincal trial options mthan others (e.g. UPS and immunotherapy; DDLPS and MDM2 inhibitors) . Attention to diet and nutriton can also improve tolerance not only of surgery, but also improve pre-adjuvant tor adjuvant chemotherapy and radiaton (see also Anderson PM, Thomas, S et al "Strategies to mitigate chemotherapy and radiaton toxicities that affect eating"  Nutrients  2021, 13 , 4397" . In summary often surgery for oligometastatic disease is VERY reasonable!.This paper provides perspective and should help with peer-to-peer  and tumor board discussions..

Author Response

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