Comparison of radiological and pathohistological response to neoadjuvant chemotherapy combined with regional hyperthermia (RHT) and study of response dependence on the applied thermal parameters in patients with soft tissue sarcomas (STS)

Stahl, Robert; Wang, Tungte; Lindner, Lars H.; Abdel-Rahman, S.; Santl, M.; Reiser, Maximilian; Issels, Rolf D.

doi:10.1080/02656730902873616

Cited by 16 publications

(14 citation statements)

References 28 publications

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“…Furthermore, changes in radiographic tumor size, as measured by RECIST, also seem to be a poor surrogate of disease control and oncologic outcome 18,20. Our findings are consistent with both of these conclusions and reaffirm that novel imaging end points for STS are needed 17,21…”

Section: Discussionsupporting

confidence: 85%

Radiographic and Histologic Response to Neoadjuvant Radiotherapy in Patients With Soft Tissue Sarcoma

et al. 2010

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BackgroundLimited data exist regarding the radiographic and histologic response of soft tissue sarcoma (STS) to neoadjuvant radiotherapy (RT).MethodsBetween February 2000 and January 2009, a total of 25 patients aged >16 years with intermediate- or high-grade primary STS of all sites were treated with neoadjuvant RT followed by definitive resection. Patients receiving chemoradiotherapy were excluded. Cross-sectional images obtained before and after RT as well as pathologic specimens were reviewed for maximal change in tumor diameter and percentage tumor necrosis, respectively. Clinicopathologic variables were analyzed for their association with pathologic and radiographic response.ResultsThere were 18 extremity (72%) and 7 retroperitoneal (28%) tumors. Median maximal tumor size was 9 cm (range, 3.3–35 cm), and 88% were of high grade. There were 21 R0 resections (84%) and 4 R1 resections (16%). Radiographically, the median percentage change in tumor diameter was 0% (range, −25 to +86%). By Response Evaluation Criteria in Solid Tumors (RECIST), 5 patients demonstrated progressive disease, 20 demonstrated stable disease, and 0 demonstrated partial/complete response. The median pathologic percentage tumor necrosis was 30% (range, 5–100%). Two tumors (8%) demonstrated near-complete pathologic response (≥95% necrosis). Near-complete pathologic response was associated with favorable oncologic outcomes, although these associations were not statistically significant.ConclusionsRadiologic and near-complete pathologic responses are rare events after preoperative RT for STS. Near-complete pathologic response may be a potentially meaningful surrogate marker for disease outcome and is not predicted by RECIST response. Knowledge of these historical response rates is important for the evaluation of novel neoadjuvant therapies for patients with STS.

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Section: Discussionsupporting

confidence: 85%

Radiographic and Histologic Response to Neoadjuvant Radiotherapy in Patients With Soft Tissue Sarcoma

et al. 2010

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“…chemotherapy)-induced changes of sarcomas measured clinical response with all 3 possible radiological anatomic response criteria from unidimensional to tridimensional, which is similar to this study. In general, the study by Stahl et al 21 failed to document a correlation between radiology and pathology, especially for radiologic partial responders and cases with stable disease. The authors concluded that anatomic response criteria may be able to detect only progressive disease stages.…”

Section: Discussionmentioning

confidence: 94%

“…[16][17][18] Similar to our results, others observed that cystic degeneration as part of posttherapeutic tumor changes are often associated with tumor size increases in pathological responders after RT. 19,20 A study by Stahl et al 21 of the hyperthermia (? chemotherapy)-induced changes of sarcomas measured clinical response with all 3 possible radiological anatomic response criteria from unidimensional to tridimensional, which is similar to this study.…”

Section: Discussionmentioning

confidence: 99%

Size-Based Clinical Response Evaluation is Insufficient to Assess Clinical Response of Sarcomas Treated with Isolated Limb Perfusion with TNF-α and Melphalan

et al. 2012

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“…However other means of response evaluation, especially radiological re-staging during or shortly after neoadjuvant treatment, are even less reliable. Re-Staging does neither seem to correlate with histopathological response nor with outcome after preoperative HCT or radiotherapy [47][48][49]. Therefore histological evaluation can still be regarded as the gold standard for response evaluation.…”

Section: Discussionmentioning

confidence: 97%

Neoadjuvant chemotherapy plus radiation versus chemotherapy plus regional hyperthermia in high-grade soft tissue sarcomas: a retrospective comparison

Zschaeck

Wust

Melcher

et al. 2018

International Journal of Hyperthermia

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Purpose: Localized adult high-grade soft tissue sarcomas (STS) usually require multimodality treatment including surgery, radiotherapy, chemotherapy and hyperthermia. If maximal preoperative tumorshrinkage is envisaged, neoadjuvant chemotherapy þ radiation (CRT) is often applied, however at the expense of relatively high toxicities and increased postoperative complication rates. This study aims to compare preoperative CRT with neoadjuvant chemotherapy þ regional hyperthermia (HCT) regarding histopathological response, toxicity and outcome. Methods: In this retrospective analysis, 61 consecutive high-grade STS patients treated between 2009 and 2016 were included. All patients were treated within a prospective treatment protocol. 28 patients received neoadjuvant CRT 33 patients HCT. CRT consisted of four cycles doxorubicin/ifosfamide and two cycles ifosfamide concomitant to 50.4 Gray external beam radiotherapy. HCT consisted of 4-6 cycles doxorubicin/ifosfamide with deep regional hyperthermia administered biweekly during each cycle. Association of treatment modality with overall survival (OS), local control (LC) and freedom from distant metastases (FFDM) was evaluated by Kaplan-Meier and log-rank analyses. Results: The overall patient characteristics were well balanced. Histopathological tumor response did not differ significantly between both groups (p ¼ .67), neither did higher-grade toxicities during neoadjuvant treatment. Wound dehiscence (p ¼ .018) and surgical hospital re-admissions (p < .001) were both significantly more frequent in the CRT group. Two-year OS, LC and FFDM rates of all patients were 93, 85 and 71% with no significant differences between CRT and HCT. Conclusion: Compared to CRT, HCT seems equally efficient and appears to bear less surgical complications. Interpretation should be cautious due to the low number of patients and the retrospective nature of this study.

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Comparison of radiological and pathohistological response to neoadjuvant chemotherapy combined with regional hyperthermia (RHT) and study of response dependence on the applied thermal parameters in patients with soft tissue sarcomas (STS)

Cited by 16 publications

References 28 publications

Radiographic and Histologic Response to Neoadjuvant Radiotherapy in Patients With Soft Tissue Sarcoma

Radiographic and Histologic Response to Neoadjuvant Radiotherapy in Patients With Soft Tissue Sarcoma

Size-Based Clinical Response Evaluation is Insufficient to Assess Clinical Response of Sarcomas Treated with Isolated Limb Perfusion with TNF-α and Melphalan

Neoadjuvant chemotherapy plus radiation versus chemotherapy plus regional hyperthermia in high-grade soft tissue sarcomas: a retrospective comparison

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