MR-imaging changes of musculoskeletal soft-tissue sarcomas associated with neoadjuvant chemotherapy and hyperthermia

Baur, Andrea; Stäbler, A; Wendtner, Clemens-M.; Arbogast, Susanne; Rahman, Shamima; Santl, M.; Issels, Rolf D.; Reiser, Maximilian

doi:10.1080/0265673021000058366

Cited by 17 publications

(11 citation statements)

References 24 publications

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“…Baur et al [20] showed in a magnetic resonance imaging (MRI) study that neoadjuvant chemotherapy combined with RHT resulted in significant reduction of tumor size and induction of tumor necrosis. Tumor necrosis occurred in some patients already after one cycle of treatment.…”

Section: Discussionmentioning

confidence: 98%

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

Wang

Lindner

et al. 2009

International Journal of Hyperthermia

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Section: Discussionmentioning

confidence: 98%

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

Wang

Lindner

et al. 2009

International Journal of Hyperthermia

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“…There was also substantial to excellent agreement regarding the evaluation of response at conventional MR imaging, DWI, and DCE imaging (k = 0.795, 0.840, and 0.773, respectively), and excellent agreement in the measurements of the ADCs (intraclass correlation coefficient, 0.8335; 95% confidence interval, 0.7729, 0.8791). response in soft-tissue sarcomas (20), although it can show tumor volume reduction from pretreatment imaging, as well as cystic regions presumed to be tumor necrosis (21,27,28 with alterations in tumor perfusion after neoadjuvant treatment, and ADCs are inversely related to tumor cellularity (17). Unlike DCE, DWI is a noncontrast technique and a potentially useful alternative for assessing response in patients with contraindications to the use of contrast material.…”

Section: Discussionmentioning

confidence: 99%

Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences

Soldatos¹,

Ahlawat²,

Montgomery³

et al. 2016

Radiology

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).q RSNA, 2015 Purpose:To determine the added value of quantitative diffusionweighted and dynamic contrast material-enhanced imaging to conventional magnetic resonance (MR) imaging for assessment of the response of soft-tissue sarcomas to neoadjuvant therapy. Materials and Methods:MR imaging examinations in 23 patients with soft-tissue sarcomas who had undergone neoadjuvant therapy were reviewed by two readers during three sessions: conventional imaging (T1-weighted, fluid-sensitive, static postcontrast T1-weighted), conventional with diffusion-weighted imaging, and conventional with diffusion-weighted and dynamic contrast-enhanced imaging. For each session, readers recorded imaging features and determined treatment response. Interobserver agreement was assessed and receiver operating characteristic analysis was performed to evaluate the accuracy of each session for determining response by using results of the histologic analysis as the reference standard. Good response was defined as less than or equal to 5% residual viable tumor. Results:Of the 23 sarcomas, four (17.4%) showed good histologic response (three of four with .95% granulation tissue and ,5% necrosis, one of four with 95% necrosis and ,5% viable tumor) and 19 (82.6%) showed poor response (viable tumor range, 10%-100%). Interobserver agreement was substantial or excellent for imaging features in all sequences (k = 0.789-1.000). Receiver operating characteristic analysis showed an increase in diagnostic performance with the addition of diffusion-weighted and dynamic contrast-enhanced MR imaging for prediction of response compared with that for conventional imaging alone (areas under the curve, 0.500, 0.676, 0. Conclusion:Adding functional sequences to the conventional MR imaging protocol increases the sensitivity of MR imaging for determining treatment response in soft-tissue sarcomas.q RSNA, 2015

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“…Enhanced drug cytotoxicity by simultaneous heating in vivo has been shown to increase the fraction of necrotic areas within the tumor tissue as a surrogate marker of tumor response to the combined treatment [10,11]. At temperatures over 40°C, proteins become structurally unstable and may even unfold leading to loss of function and to intracellular accumulation.…”

Section: Enhancement Of Drug Cytotoxicity By Hyperthermiamentioning

confidence: 98%

Hyperthermia in soft tissue sarcoma

Lindner

Issels

2011

Curr. Treat. Options in Oncol.

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Patients with high-risk soft tissue sarcomas (STS)-FNCLCC grade 2-3, size >5 cm, deep to the fascia-are at risk for developing local recurrence and distant metastasis despite surgical tumor resection. Therefore, the management of high-risk STS requires a multidisciplinary approach. Besides surgery, radiotherapy, and chemotherapy, regional hyperthermia (RHT) has the potential to become the fourth standard treatment modality for the treatment of these patients. RHT means non-invasive selective heating of the tumor area to temperatures within the range of 40-43°C for 60 min by the use of an electromagnetic heating device. Thereby RHT is always applied in addition to radiotherapy or chemotherapy or both but is not effective as a single treatment. Beside direct cytotoxicity, RHT in combination with chemotherapy enhances the drug cytotoxicity mainly by increased chemical reaction and intratumoral drug accumulation. For the neoadjuvant setting, RHT in combination with a doxorubicin- and ifosfamide-based chemotherapy has been shown to dramatically improve the tumor response rate but also prevents from early disease progression as compared to chemotherapy alone. The addition of RHT to a multimodal treatment of high-risk STS consisting of surgery, radiotherapy, and chemotherapy either in the neoadjuvant setting but also after incomplete or marginal tumor resection has been shown to significantly improve local recurrence- and disease-free survival. Based on these results and in conjunction with the low RHT-related toxicity, RHT combined with preoperative or postoperative chemotherapy should be considered as an additional standard treatment option for the multidisciplinary treatment of locally advanced high-grade STS.

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MR-imaging changes of musculoskeletal soft-tissue sarcomas associated with neoadjuvant chemotherapy and hyperthermia

Abstract: Neoadjuvant chemotherapy combined with RHT resulted in significant tumour volume reduction and induction of tumour necrosis, which can be detected early and monitored closely with MRI.

Cited by 17 publications

References 24 publications

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)

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)

Multiparametric Assessment of Treatment Response in High-Grade Soft-Tissue Sarcomas with Anatomic and Functional MR Imaging Sequences

Hyperthermia in soft tissue sarcoma

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