This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eilber, F. C. Articles by Eilber, F. R. Search for Related Content PubMed PubMed Citation Articles by Eilber, F. C. Articles by Eilber, F. R. Social Bookmarking                            What's this?

Treatment-Induced Pathologic Necrosis: A Predictor of Local Recurrence and Survival in Patients Receiving Neoadjuvant Therapy for High-Grade Extremity Soft Tissue Sarcomas

From the Divisions of Surgical Oncology, Medical Oncology, Orthopedic Surgery, Surgical Pathology, Radiation Oncology, and Biostatistics, University of California Los Angeles Sarcoma Research Group, University of California Los Angeles, Los Angeles, CA.

Address reprint requests to Frederick R. Eilber, MD, Division of Surgical Oncology, 54-140 CHS, University of California Los Angeles Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095-1782; email: feilber{at}surgery.medsch.ucla.edu

PURPOSE: To determine whether treatment-induced pathologic necrosis correlates with local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas.

PATIENTS AND METHODS: Four hundred ninety-six patients with intermediate- to high-grade extremity soft tissue sarcomas received protocol neoadjuvant therapy. All patients underwent surgical resection after neoadjuvant therapy and had pathologic assessment of tumor necrosis in the resected specimens.

RESULTS: The 5- and 10-year local recurrence rates for patients with 95% pathologic necrosis were significantly lower (6% and 11%, respectively) than the local recurrence rates for patients with less than 95% pathologic necrosis (17% and 23%, respectively). The 5- and 10-year survival rates for the patients with 95% pathologic necrosis were significantly higher (80% and 71%, respectively) than the survival rates for the patients with less than 95% pathologic necrosis (62% and 55%, respectively). Patients with less than 95% pathologic necrosis were 2.51 times more likely to develop a local recurrence and 1.86 times more likely to die of their disease as compared with patients with 95% pathologic necrosis. The percentage of patients who achieved 95% pathologic necrosis increased to 48% with the addition of ifosfamide as compared with 13% of the patients in all the other protocols combined.

CONCLUSION: Treatment-induced pathologic necrosis is an independent predictor of both local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. A complete pathologic response ( 95% pathologic necrosis) correlated with a significantly lower rate of local recurrence and improved overall survival.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. R. Benz, J. Czernin, M. S. Allen-Auerbach, W. D. Tap, S. M. Dry, D. Elashoff, K. Chow, V. Evilevitch, J. J. Eckardt, M. E. Phelps, et al. FDG-PET/CT Imaging Predicts Histopathologic Treatment Responses after the Initial Cycle of Neoadjuvant Chemotherapy in High-Grade Soft-Tissue Sarcomas Clin. Cancer Res., April 15, 2009; 15(8): 2856 - 2863. [Abstract] [Full Text] [PDF]

				H. W. Garner, M. J. Kransdorf, L. W. Bancroft, J. J. Peterson, T. H. Berquist, and M. D Murphey Benign and Malignant Soft-Tissue Tumors: Posttreatment MR Imaging RadioGraphics, January 1, 2009; 29(1): 119 - 134. [Abstract] [Full Text] [PDF]

				M. R. Benz, M. S. Allen-Auerbach, F. C. Eilber, H. J.J. Chen, S. Dry, M. E. Phelps, J. Czernin, and W. A. Weber Combined Assessment of Metabolic and Volumetric Changes for Assessment of Tumor Response in Patients with Soft-Tissue Sarcomas J. Nucl. Med., October 1, 2008; 49(10): 1579 - 1584. [Abstract] [Full Text] [PDF]

				D. R. Lucas, M. P. Kshirsagar, J. S. Biermann, M. R. Hamre, D. G. Thomas, S. M. Schuetze, and L. H. Baker Histologic Alterations from Neoadjuvant Chemotherapy in High-Grade Extremity Soft Tissue Sarcoma: Clinicopathological Correlation Oncologist, April 1, 2008; 13(4): 451 - 458. [Abstract] [Full Text] [PDF]

				V. Evilevitch, W. A. Weber, W. D. Tap, M. Allen-Auerbach, K. Chow, S. D. Nelson, F. R. Eilber, J. J. Eckardt, R. M. Elashoff, M. E. Phelps, et al. Reduction of Glucose Metabolic Activity Is More Accurate than Change in Size at Predicting Histopathologic Response to Neoadjuvant Therapy in High-Grade Soft-Tissue Sarcomas Clin. Cancer Res., February 1, 2008; 14(3): 715 - 720. [Abstract] [Full Text] [PDF]

				V. H. C. Bramwell Controversies in Surgical Oncology: Routine Anthracycline-based Adjuvant Chemotherapy for Stage III Extremity Soft Tissue Sarcoma Ann. Surg. Oncol., April 1, 2007; 14(4): 1254 - 1256. [Full Text] [PDF]

				E. Hendershot, A. Pappo, D. Malkin, and L. Sung Tumor Necrosis in Pediatric Osteosarcoma: Impact of Modern Therapies Journal of Pediatric Oncology Nursing, July 1, 2006; 23(4): 176 - 181. [Abstract] [PDF]

				L. A. Mack, P. J. Crowe, J. L. Yang, N. S. Schachar, D. G. Morris, E. C. Kurien, C. L. F. Temple, R. L. Lindsay, E. Magi, W. G. DeHaas, et al. Preoperative Chemoradiotherapy (Modified Eilber Protocol) Provides Maximum Local Control and Minimal Morbidity in Patients With Soft Tissue Sarcoma Ann. Surg. Oncol., August 1, 2005; 12(8): 646 - 653. [Abstract] [Full Text] [PDF]

				A. S. Pappo, M. Devidas, J. Jenkins, B. Rao, R. Marcus, P. Thomas, M. Gebhardt, C. Pratt, and H. E. Grier Phase II Trial of Neoadjuvant Vincristine, Ifosfamide, and Doxorubicin With Granulocyte Colony-Stimulating Factor Support in Children and Adolescents With Advanced-Stage Nonrhabdomyosarcomatous Soft Tissue Sarcomas: A Pediatric Oncology Group Study J. Clin. Oncol., June 20, 2005; 23(18): 4031 - 4038. [Abstract] [Full Text] [PDF]

				G. J. Kelloff, J. M. Hoffman, B. Johnson, H. I. Scher, B. A. Siegel, E. Y. Cheng, B. D. Cheson, J. O'Shaughnessy, K. Z. Guyton, D. A. Mankoff, et al. Progress and Promise of FDG-PET Imaging for Cancer Patient Management and Oncologic Drug Development Clin. Cancer Res., April 15, 2005; 11(8): 2785 - 2808. [Abstract] [Full Text] [PDF]

				F. C. Eilber, M. F. Brennan, E. Riedel, K. M. Alektiar, C. R. Antonescu, and S. Singer Prognostic Factors for Survival in Patients With Locally Recurrent Extremity Soft Tissue Sarcomas Ann. Surg. Oncol., March 1, 2005; 12(3): 228 - 236. [Abstract] [Full Text] [PDF]

				S. R. Grobmyer, R. G. Maki, G. D. Demetri, M. Mazumdar, E. Riedel, M. F. Brennan, and S. Singer Neo-adjuvant chemotherapy for primary high-grade extremity soft tissue sarcoma Ann. Onc., November 1, 2004; 15(11): 1667 - 1672. [Abstract] [Full Text] [PDF]

				A. J. Mundt, S. Vijayakumar, J. Nemunaitis, A. Sandler, H. Schwartz, N. Hanna, T. Peabody, N. Senzer, K. Chu, C. S. Rasmussen, et al. A Phase I Trial of TNFerade Biologic in Patients with Soft Tissue Sarcoma in the Extremities Clin. Cancer Res., September 1, 2004; 10(17): 5747 - 5753. [Abstract] [Full Text] [PDF]

				P. W.T. Pisters, S. R. Patel, V. G. Prieto, P. F. Thall, V. O. Lewis, B. W. Feig, K. K. Hunt, A. W. Yasko, P. P. Lin, M. G. Jacobson, et al. Phase I Trial of Preoperative Doxorubicin-Based Concurrent Chemoradiation and Surgical Resection for Localized Extremity and Body Wall Soft Tissue Sarcomas J. Clin. Oncol., August 15, 2004; 22(16): 3375 - 3380. [Abstract] [Full Text] [PDF]

				J. N. Cormier and R. E. Pollock Soft Tissue Sarcomas CA Cancer J Clin, March 1, 2004; 54(2): 94 - 109. [Abstract] [Full Text] [PDF]

				G. Bacci, S. P. Scully, M. A. Ghert, D. Zurakowski, R. C. Thompson Jr., and M. C. Gebhardt Pathologic Fracture in Osteosarcoma J. Bone Joint Surg. Am., September 1, 2003; 85(9): 1848 - 1849. [Full Text] [PDF]

				S. L. Spunt, D. A. Hill, A. M. Motosue, C. A. Billups, A. M. Cain, B. N. Rao, C. B. Pratt, T. E. Merchant, and A. S. Pappo Clinical Features and Outcome of Initially Unresected Nonmetastatic Pediatric Nonrhabdomyosarcoma Soft Tissue Sarcoma J. Clin. Oncol., August 1, 2002; 20(15): 3225 - 3235. [Abstract] [Full Text] [PDF]

				C.-M. Wendtner, S. Abdel-Rahman, M. Krych, J. Baumert, L. H. Lindner, A. Baur, W. Hiddemann, and R. D. Issels Response to Neoadjuvant Chemotherapy Combined With Regional Hyperthermia Predicts Long-Term Survival for Adult Patients With Retroperitoneal and Visceral High-Risk Soft Tissue Sarcomas J. Clin. Oncol., July 15, 2002; 20(14): 3156 - 3164. [Abstract] [Full Text] [PDF]

				M. C. Gebhardt What's New in Musculoskeletal Oncology J. Bone Joint Surg. Am., April 1, 2002; 84(4): 694 - 701. [Full Text] [PDF]