Assessing Treatment Response in Soft Tissue Sarcoma Using Dynamic Contrast-Enhanced MRI: A Systematic Review

Area of Science:

• Radiology and Oncology
• Medical Imaging
• Soft Tissue Sarcoma Research

Background:

• Conventional size-based criteria inadequately assess neoadjuvant therapy (NAT) response in soft tissue sarcomas (STS).
• Accurate response assessment is crucial for tailoring NAT and improving patient outcomes in STS.

Purpose of the Study:

• To systematically review the association between dynamic contrast-enhanced MRI (DCE-MRI) parameters and histopathology-based NAT response in STS.
• To identify DCE-MRI parameters with consistent associations with treatment response across diverse clinical contexts.

Main Methods:

• Systematic review following PRISMA guidelines.
• Comprehensive literature search for studies evaluating NAT response in STS using DCE-MRI.
• Inclusion of 13 studies with 234 patients.

Main Results:

• Quantitative DCE-MRI parameters, especially K^trans, demonstrated strong predictive performance and discriminatory ability for treatment response.
• Related parameters (ΔK^trans, K_ep, V_e) correlated significantly with histopathologic necrosis.
• Semi-quantitative (iAUC60, wash-in rate) and qualitative (type II curves) markers showed consistent associations with tumor perfusion, hypoxia, and favorable outcomes.

Conclusions:

• DCE-MRI, particularly quantitative pharmacokinetic parameters like K^trans, shows significant promise for assessing NAT response in STS.
• Parameter associations with histopathology-based response are generally concordant.
• Need for standardized prospective validation due to heterogeneity and small cohort sizes.