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

Crystal Seldon1, Gautam Shrivastava1, Melanie Fernandez1

  • 1Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.

Cancers
|April 3, 2021
PubMed
Summary

Neoadjuvant chemoradiation (NA-CRT) significantly improves pathologic complete response (pCR) rates in soft tissue sarcomas (STS) compared to radiation (NA-XRT) or chemotherapy (NA-CT) alone. Higher grade tumors also show increased pCR with NA-CRT.

Keywords:
neoadjuvant therapypathologic complete responsesoft tissue sarcoma

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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.