Prospective comparison of various radiological response criteria and pathological response to preoperative chemotherapy and survival in operable high-grade soft tissue sarcomas in the Japan Clinical Oncology Group study JCOG0304

Abstract

BackgroundSoft tissue sarcomas (STS) are rare malignant tumors. The efficacy of preoperative chemotherapy for STS is evaluated using various tumor size-based radiological response criteria. However, it is still unclear which set of criteria would show the best association with pathological response and survival of the patients with STS.MethodsWe compared radiological responses to preoperative chemotherapy for operable STS by the Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST, World Health Organization criteria, Japanese Orthopaedic Association criteria, and modified Choi criteria and analyzed the association with pathological response and survival using the data from the Japan Clinical Oncology Group (JCOG) study JCOG0304, a phase II clinical trial evaluating the efficacy of perioperative chemotherapy for STS in the extremities.ResultsSeventy eligible patients in JCOG0304 were analyzed. The results demonstrated that none of the size-based radiological response criteria showed significant association with pathological response to preoperative chemotherapy for STS. The difference between overall survival of the patients assessed as partial response and stable disease/progressive disease by RECIST was not significant (hazard ratio 1.37, p = 0.63), and calculated C-index was 0.50. All other response criteria also could not exhibit significant association between radiological responses and survival.ConclusionIn the present study, none of the radiological response criteria analyzed demonstrated association of response to preoperative chemotherapy with pathological response or survival of the patients with operable STS. Further prospective investigation is required to develop criteria to evaluate not only tumor shrinkage but biological effects of preoperative chemotherapy for the patients with localized STS.Trial registrationUMIN Clinical Trials Registry C000000096. Registered 30 August, 2005 (retrospectively registered).

Standardization of evaluation method and prognostic significance of histological response to preoperative chemotherapy in high-grade non-round cell soft tissue sarcomas

“…Especially in STS, the radiological response to preoperative chemotherapy is not reliable prognostic predictor. In JCOG0304, the radiological response demonstrated no association with survival of patients with operable soft tissue sarcoma [ 8 ]. It is particularly worth noting that histological responders in our study showed an excellent prognosis, achieving up to 92.0% of 10-year OS.…”

“…Even when chemotherapy is effective, STS is not always reduced, as the tumor diameter sometimes gets enlarged because of the expansion in tumor mass due to intratumoral hemorrhage, necrosis, edema, fibrosis, and hyalinization caused by antitumor agents. A correlation between changes in tumor size on the radiological images and patient prognosis is controversial [ 8 , 9 ]. Similarly, the prognostic significance of histological response to preoperative chemotherapy in high-grade STS has not been established yet.…”

Clinical Perspectives for 18F-FDG PET Imaging in Pediatric Oncology: Μetabolic Tumor Volume and Radiomics

“…Good responders are considered those with viable tumor cells <10% in the post-surgical specimen [ 64 , 65 ]. This means that tumor volume reduction evaluated by response evaluation criteria in solid tumors (RECIST), or similar conventional imaging criteria, cannot predict histopathological response [ 82 , 83 , 84 ]. Radiological response (tumor volume regression with a cut-off value of 50%) is only used for unresectable tumors, in which pathology could not be predictive of survival and local control is based on radiotherapy [ 65 ].…”

Standardization of Evaluation Method and Prognostic Significance of Histological Response to Preoperative Chemotherapy in High-grade Non-round Cell Soft Tissue Sarcomas: a Report From the Central Pathology Review for the Japan Clinical Oncology Group Study JCOG0304

“…Even when chemotherapy is effective, STS is not always reduced, as the tumor diameter sometimes gets enlarged because of the expansion in tumor mass due to intratumoral hemorrhage and necrosis caused by antitumor agents. A correlation between changes in tumor size on the radiological images and patient prognosis is controversial (Tanaka et al 2018;Ueda et al 2008). Similarly, the prognostic signi cance of histological response to preoperative chemotherapy in high-grade STS has not been established yet.…”