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2014 ; 120
(23
): 3676-82
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Prognostic significance of treatment-induced pathologic necrosis in extremity and
truncal soft tissue sarcoma after neoadjuvant chemoradiotherapy
#MMPMID25081640
Mullen JT
; Hornicek FJ
; Harmon DC
; Raskin KA
; Chen YL
; Szymonifka J
; Yeap BY
; Choy E
; DeLaney TF
; Nielsen GP
Cancer
2014[Dec]; 120
(23
): 3676-82
PMID25081640
show ga
BACKGROUND: Histologic response to chemotherapy has been shown to be an
independent prognostic factor in patients with osteosarcoma and Ewing sarcoma.
However, in patients with soft tissue sarcoma (STS), the prognostic impact of
histologic response to chemotherapy is less clear. In the current study, the
authors sought to determine the prognostic significance of treatment-induced
pathologic necrosis in patients receiving neoadjuvant chemoradiotherapy for STS.
METHODS: Between 1989 and 2011, a total of 113 patients with grade 2 or 3 (graded
according to the National Cancer Institute grading system using 3 tiers)
extremity or truncal STS were identified who received neoadjuvant interdigitated
chemoradiotherapy according to protocol followed by surgery. The extent of tumor
necrosis in the resected specimens was quantified and correlated with outcome.
RESULTS: The median tumor necrosis rate was 90%, and 103 patients (91%) received
all 3 cycles of planned neoadjuvant chemotherapy. The likelihood of achieving
?95% necrosis was not related to the number of preoperative cycles of
chemotherapy received but was found to be related to tumor histology (62% for
malignant fibrous histiocytoma vs 0% for synovial sarcoma [P<.001]; 56% for
myxoid liposarcoma vs 0% for synovial sarcoma [P?=?.002]). At a median follow-up
of 6 years, there were no statistically significant differences noted in the
5-year local control, disease-specific survival, and overall survival rates for
patients with ?95% necrosis (50 patients; 44%) and <95% necrosis (63 patients;
56%), even when stratifying by histology. CONCLUSIONS: In a homogeneous
population of patients with high-grade extremity and truncal STS who were treated
with neoadjuvant chemoradiotherapy, the extent of pathologic tumor necrosis did
not correlate with outcome.