Anthracycline/ifosfamide-based neoadjuvant chemotherapy (NAC) is considered to improve survival in adult patients (pts) with high-risk soft tissue sarcoma (HR-STS) [Gronchi A et al., Lanacet Oncology 2017; 18(6):812-22]. Regional hyperthermia (RHT) combined with NAC has significantly improved radiological tumor response and survival in pts with HR-STS [Issels RD, Lindner LH et al., JAMA Oncology 2018 2018 Feb 15. doi: 10.1001/jamaoncol.2017.4996]. The purpose of this retrospective analysis was to assess whether the pathological tumor response after NAC with doxorubicin/ifosfamide (AI) combined with RHT can predict survival outcomes in adult pts with HR-STS.
In our database, we identified 138 pts who underwent NAC with AI in combination with RHT (01/09 – 10/16) followed by resection of the residual tumor. Pathological response after NAC + RHT was assessed in seventy-five pts and correlated with survival outcome. Pathological grade of regression of the resected tumor was evaluated according to Salzer-Kuntschik et al. and survival parameters using Kaplan Meier. In the patient group, we identified 28 pts with L-sarcoma (LS, lipo- and leiomyosarcoma) and 47 pts with non-LS.
All 75 pts (22 – 78y, median age 60y) received perioperative (1 – 8 cycles, median 6 cycles) combined with RHT (2 – 16 RHT, median 8 RHT), 23 pts underwent neoadjuvant radiotherapy (NAR). Overall survival (OS) and disease progression free survival (DFS) was not significantly improved for a higher grade of regression, whereas pts with pathological regression grade ≥ 3 (n = 26) had a significant better local relapse free survival (LRFS) than pts with regression grade < 3 (n = 49) (p = 0.017).
Histopathological grade of regression after NAC + RHT seems to be predictive for LRFS in adult patients with HR-STS. Further investigations on molecular markers that can predict histopathological response are needed.
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