DR. BRENNAN: Questions or comments without addressing the detail of a trial that is not even written yet, but the concept? It is the number one problem in retroperitoneal sarcoma. I think we are all comfortable about that. Local recurrence kills people.

DR. O'SULLIVAN: I just wonder about the issue of not being able to get accrual to the RTOG phase II protocol is a good surrogate for not being able to do this trial. I am not saying that you are not going to get accrual. But it brings in another modality that is probably less commonly used for this disease from the point of systemic treatment rather than surgery and radiotherapy, which I think most people either believe in or feel there is a genuine controversy. I think it is a different situation. For example, we probably would have trouble convincing our medical oncologists to be involved in the RTOG protocol, whereas I think most of the population involved in managing retroperitoneal would accept that something around this area should be looked at.

DR. PISTERS: I think that is a fair comment. I would say, however, that the other major centers in this country that have an interest and an established track record with pre-operative radiation certainly include the Mayo Clinic and the MGH group. Among the clinicians in those centers, they all have told us that the chemotherapy is an important part of that.

If we all assume that successful completion of such a trial would require participation of groups such as the Mayo Clinic and MGH, I think that the current accrual to that protocol would be an important barometer to assess participation. If those centers can't put patients on, if we can't put patients on at our center, that is going to be a bad sign.

DR. NIELSEN: In the EORTC we have also been discussing strategies in retroperitoneal sarcomas. As we discussed in the Intergroup meeting here Sunday evening, we would definitely be very positive to join such a study. Martin Robertson, who is the chairman of our local treatment subcommittee, actually made me bring the message that we were very interested to do a study, and we would very much support that it should be as simple as possible to have a clear answer.
It is an ongoing study. Therefore, I think it is very important that it is a clear and simple study. We are positive to join such a one.

DR. BENJAMIN: We were talking earlier about lumping and splitting sarcomas, and now we are back to lumping, and I wonder whether that is an appropriate strategy. We know that, in the retroperitoneum, there are tumors with very diverse biology. Would it not be possible to do a study where the same question was addressed in the tumors which have purely local recurrence as their mode of failure?

DR. BRENNAN: I think that is purely for the group to put together. I think low-grade liposarcoma is the question I am looking at, and we don't use chemotherapy for it, and would, I think, go with Brian and enter, I hope, all those people.
I think we have all had more difficulties depending on not including high-grade leiomyosarcoma; but I think that is a detail, perhaps, for Peter and the people he leads in defining the question.

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