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Deprecated: Implicit conversion from float 265.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Cancer 2014 ; 120 (23): 3676-82 Nephropedia Template TP
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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 PMID25081640show ga
Background: Histologic response to chemotherapy has been shown to be an independent prognostic factor in patients with osteosarcoma and Ewing?s sarcoma. However, in patients with soft tissue sarcoma (STS), the prognostic impact of histologic response to therapy is less clear. We sought to determine the prognostic significance of treatment-induced pathologic necrosis in patients receiving neoadjuvant chemoradiotherapy for STS. Methods: Between 1989 and 2011, we identified 113 patients with grade 2 or 3 extremity or truncal STS who received protocol neoadjuvant interdigitated chemoradiotherapy followed by surgery. We quantified the extent of tumor necrosis in the resected specimens and correlated this with outcome. Results: The median tumor necrosis was 90%, and 103 (91%) patients received all 3 cycles of planned neoadjuvant chemotherapy. The likelihood of achieving ? 95% necrosis was not related to the number of pre-operative cycles of chemotherapy received but was related to tumor histology (MFH 62% versus synovial sarcoma 0%, p<0.001; myxoid liposarcoma 56% versus synovial sarcoma 0%, p=0.002). At a median follow-up of 6 years, there were no statistically significant differences in the 5-year local control, disease-specific, and overall survival rates for patients with ? 95% necrosis (n = 50, 44%) and < 95% necrosis (n = 63, 56%), even when stratifying by histology. Conclusions: In a homogeneous population of patients with high-grade extremity and truncal STS treated with neoadjuvant chemoradiotherapy, the extent of pathologic tumor necrosis did not correlate with outcome.