Correlation of Radiologic and Pathologic Response in Patients Receiving Neoadjuvant Radiotherapy for Soft Tissue Sarcoma
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 2
Abstract
Background: It is unknown if the radiologic response after neoadjuvant radiation (RT) in patients with soft tissue sarcoma correlates with the histologic response or disease outcomes. The purpose of this study is to evaluate radiographic and histologic responses in patients who received neoadjuvant RT, and to evaluate the relation between these short-term surrogates. Patients and Methods: We sought to review consecutive patients with primary localized STS, who were treated with preoperative RT, between 2016 and 2018 at a single institution. All patients were required to have initiated RT with the intention to be followed by curative surgical resection. Data on demographics and disease characteristics were retrospectively collected, the tumor volume (cc) was calculated before and after RT, pathology specimens were reviewed for percent of necrosis and status of surgical margins. Results: Twenty-three patients with primary localized STS were treated with preoperative radiotherapy followed by surgery. There were 11 extremity (48%), 7 retroperitoneal (30%) and 5 thoracic (22%) tumors. The tumor volume decreased after neoadjuvant RT in 10 cases (43%) to a maximum of 50% (range, -5 to -50%), while in eight patients (35%) the tumor grew in size to a maximum of 40% (range, +10 to +40%). The tumor volume was stable in five patients (22%). Complete resection (R0) was achieved in 18 cases (79%), microscopically involved margins (R1) were observed in 4 (17%), and gross residual (R2) in one patient (4%). The median tumor necrosis was 40%. Five patients (22%) demonstrated complete or near-complete pathologic response (> 95% necrosis). Pearson correlation coefficient test revealed no correlation between radiologic and histologic responses (- 0.07). Major wound complication after surgery was observed in four patients (17%). Conclusion: Radiologic response after neo-adjuvant RT was a poor predictor of pathologic response. Complete and near complete histologic responses seem to be associated with favorable clinical outcomes. Larger studies are needed to test these surrogates in a prospective fashion.Soft tissue sarcomas are exceedingly rare tumors that account for 1% of all human malignancies. More than 50 histologic subtypes of STS are recognized. Limb salvage surgery and radiation (RT) are the standard of care in management of extremity sarcomas [1]. The timing of RT; whether preoperative or postoperative, has been tested in a prospective trial [2], both approaches have comparable oncologic outcomes in terms of local control and survival. However, preoperative RT was found to have a higher risk of major wound complications. On the contrary, late side effects such as fibrosis, joint stiffness and edema were more prevalent in patients receiving postoperative RT [3]. Soft tissue sarcoma volume usually changes after neoadjuvant RT. Many physicians perceive this response as a sign for disease response and treatment outcome. However, this suggestion was not studied nor proven. Another surrogate is post-treatment tumor necrosis; the effect of histologic response on disease outcome is not well defined and data are conflicting.
Authors and Affiliations
Ramiz Abu Hijlih, Sara Mheid, Fawzi Abuhijla, Wafa Asha, Issa Mohamad, Sameer Yaser, Ahmed Shehadeh, Samer Abdal, Abdelatif Almousa
Keywords
Related Articles
- EP ID EP592877
- DOI 10.26717/BJSTR.2018.09.001765
- Views 164
- Downloads 0
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