Pathologic Response Rates after Neoadjuvant Therapy for Sarcoma: A Single Institution Study

Area of Science:

• Oncology
• Surgical Pathology
• Radiotherapy

Background:

• Pathologic necrosis is a key indicator of treatment response in soft tissue sarcomas (STS).
• The efficacy of neoadjuvant treatments on achieving pathologic complete response (pCR) in STS remains unclear.
• This study investigates the comparative effectiveness of different neoadjuvant strategies for STS.

Purpose of the Study:

• To determine if neoadjuvant chemoradiation (NA-CRT) achieves higher pCR rates than neoadjuvant radiation (NA-XRT) or chemotherapy (NA-CT) alone in extremity STS.
• To identify factors associated with achieving pCR in patients undergoing neoadjuvant therapy for STS.

Main Methods:

• Retrospective analysis of 79 patients with extremity STS treated between 2011-2020 with neoadjuvant therapy.
• pCR defined as ≥90% necrosis in the surgical specimen.
• Statistical analysis, including univariate and multivariate analyses, to compare treatment outcomes and identify predictors of pCR.

Main Results:

• Twenty-six (32.9%) patients achieved pCR.
• Both NA-CT and NA-XRT were significantly associated with lower rates of pCR compared to NA-CRT (p < 0.01).
• Grade 3 tumors demonstrated a significantly higher likelihood of achieving pCR compared to grade 2 tumors (p < 0.05).

Conclusions:

• NA-CRT is a superior neoadjuvant treatment strategy for achieving pCR in extremity STS.
• The findings suggest that NA-CRT may be particularly beneficial for higher-grade STS.
• These results support the use of NA-CRT in the management of select STS patients.