Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for High-Grade Extremity Soft Tissue Sarcomas

Eilber, Fritz C.; Rosen, Gerald; Eckardt, Jeffery J.; Forscher, Charles; Nelson, Scott D.; Selch, Michael T.; Dorey, Frederick J.; Eilber, Frederick R.

doi:10.1200/jco.2001.19.13.3203

Cited by 301 publications

(241 citation statements)

References 28 publications

Supporting

Mentioning

227

Contrasting

Unclassified

Order By: Relevance

“…69 On the basis of these results, the authors concluded that the extent of pathologic necrosis may be considered a surrogate endpoint for survival outcomes in patients with soft tissue sarcomas. 73 The ways in which a response to induction therapy (eg, radiation therapy or chemotherapy) translates into other clinically meaningful outcomes (eg, reduction in the scope of surgical resection) are also not well defined. A recent retrospective analysis did examine the impact of preoperative chemotherapy on the scope of surgery.…”

Section: Preoperative Chemotherapymentioning

confidence: 99%

“…The incidence of treatmentinduced pathologic necrosis and its correlation with clinical outcomes are also not well defined in Soft Tissue Sarcomas patients with soft tissue sarcomas. 73 Small studies have shown complete pathologic tumor necrosis occurring in only 5% to 9% of the patients receiving doxorubicin-based induction chemotherapy. 74 -76 In addition, in a retrospective analysis of 496 patients with intermediate-and high-grade extremity soft tissue sarcomas who were treated with preoperative therapy (consisting primarily of doxorubicin-based chemotherapy and radiation therapy), complete pathologic responses (greater than or equal to 95% necrosis) were noted in only 69 patients (14%).…”

Section: Preoperative Chemotherapymentioning

confidence: 99%

See 1 more Smart Citation

Soft Tissue Sarcomas

Cormier

Pollock

2004

CA: A Cancer Journal for Clinicians

498

345

View full text Add to dashboard Cite

Sarcomas are a heterogeneous group of rare tumors that arise predominantly from the embryonic mesoderm. They present most commonly as an asymptomatic mass originating in an extremity but can occur anywhere in the body, particularly the trunk, retroperitoneum, or the head and neck. Pretreatment radiologic imaging is critical for defining the local extent of a tumor, staging the disease, guiding biopsies, and aiding in diagnosis. Core-needle biopsy is the preferred biopsy technique for diagnosing soft tissue sarcomas. The American Joint Committee on Cancer (AJCC) staging system for soft tissue sarcomas is based on histologic grade, the tumor size and depth, and the presence of distant or nodal metastases.Despite improvements in local control rates with wide local resections and radiation therapy, metastasis and death remain a significant problem in 50% of patients who present with high-risk soft tissue sarcomas. The most common site of metastasis is the lungs, and metastasis generally occurs within two to three years after the completion of therapy. Progress in the molecular characteristics of these tumors should in the near future translate into molecularly based therapies that can be incorporated into standard treatment strategies. (CA Cancer J Clin 2004;54:94 -109.) © American Cancer Society, 2004.

show abstract

Section: Preoperative Chemotherapymentioning

confidence: 99%

Section: Preoperative Chemotherapymentioning

confidence: 99%

Soft Tissue Sarcomas

Cormier

Pollock

2004

CA: A Cancer Journal for Clinicians

498

345

View full text Add to dashboard Cite

show abstract

“…1 Response to NeoCT is usually monitored using serial cross-sectional imaging. Although the pathologic response to NeoCT is a predictor of local recurrence and survival, 2 this information is available only after surgical resection. Although preoperative patient management decisions are based on the radiographic response to therapy, there is no consensus among studies that this response correlates with survival.…”

mentioning

confidence: 99%

Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas

Meric

Hess

Varma

et al. 2002

Cancer

109

View full text Add to dashboard Cite

BACKGROUNDDownstaging of large soft tissue sarcomas can be accomplished by the use of neoadjuvant chemotherapy (NeoCT). The authors tested the hypothesis that radiographic response to NeoCT predicts improved local control and survival.METHODSThe authors reviewed the medical records of 65 patients with Stage II or III soft tissue sarcoma (42 extremity, 23 retroperitoneal) who were treated with doxorubicin or ifosfamide‐based NeoCT from January 1991 to December 1996. Radiographic response and impact on surgical therapy were determined retrospectively by comparing imaging studies obtained before and after chemotherapy.RESULTSThe radiographic responses observed were partial response (PR; 22 patients [34%]); minor response (MR; 6 patients [9%]); stable disease (20 patients [31%]); and progressive disease (17 patients [26%]). Downstaging sufficient to decrease the scope of the operation occurred in 13% of the patients, 78% had no change, and 9% had disease progression sufficient to increase the scope of the operation. Patients having any radiographic response (PR or MR) had a higher margin‐negative resection rate, a better local recurrence‐free survival rate, and a better overall survival rate than did nonresponders.CONCLUSIONSThe NeoCT regimens used in this study resulted in tumor shrinkage sufficient to impact surgical therapy in a few patients. However, radiographic response predicted improved local control and overall survival rate. Cancer 2002;95:1120–6. © 2002 American Cancer Society.DOI 10.1002/cncr.10794

show abstract

“…Several non-randomized trials showed high rates of histological response [48,49] up to~50%, which correlated with outcome including overall survival [48]. Delaney et al [50] and Mullen et al [51] also described excellent results in a highly unfavourable patient group after treatment with an intensified regimen of neoadjuvant chemoradiation at Massachusetts General Hospital (MGH), although considerable rates of toxicity were observed.…”

Section: Discussionmentioning

confidence: 99%