Response Evaluation of Neoadjuvant Therapies in Sarcoma

Area of Science:

• Oncology
• Radiology
• Molecular Diagnostics

Background:

• Sarcoma treatment is evolving, with neoadjuvant therapy aiming to improve surgical and oncologic outcomes.
• Current methods for monitoring neoadjuvant treatment response in sarcoma, like RECIST and PERCIST, have limitations in real-time assessment.
• Pathologic complete response is the gold standard but requires surgical resection, precluding its use for ongoing treatment adjustment.

Purpose of the Study:

• To highlight the need for advanced tools to monitor neoadjuvant treatment response in sarcoma in real-time.
• To introduce delta-radiomics and circulating tumor DNA (ctDNA) as promising novel metrics for efficacy monitoring.
• To discuss the potential of these novel tools in tailoring neoadjuvant therapy for sarcoma patients.

Main Methods:

• Review of current and emerging methodologies for assessing neoadjuvant treatment response in sarcoma.
• Discussion of the limitations of traditional imaging-based metrics (e.g., RECIST, PERCIST).
• Exploration of delta-radiomics and ctDNA as advanced biomarkers for treatment monitoring.

Main Results:

• Delta-radiomics and ctDNA show potential to predict pathologic complete response and disease progression more effectively than current CT-based guidelines.
• Delta-radiomics is being investigated in clinical trials for adjusting radiation dosage in soft tissue sarcoma.
• ctDNA's ability to detect molecular residual disease is under study, with potential applications in sarcoma.

Conclusions:

• Delta-radiomics and ctDNA represent promising advancements for real-time monitoring of neoadjuvant treatment response in sarcoma.
• These novel metrics can potentially guide personalized therapeutic decisions prior to surgical resection.
• Future research should focus on integrating ctDNA and delta-radiomics into sarcoma clinical trials for improved treatment management.