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Prognostic significance of treatment-induced pathologic necrosis in extremity and truncal soft tissue sarcoma after neoadjuvant chemoradiotherapy.
[liposarcoma]
Histologic
response
to
chemotherapy
has
been
shown
to
be
an
independent
prognostic
factor
in
patients
with
osteosarcoma
and
Ewing
sarcoma
.
However
,
in
patients
with
soft
tissue
sarcoma
(
STS
)
,
the
prognostic
impact
of
histologic
response
to
chemotherapy
is
less
clear
.
In
the
current
study
,
the
authors
sought
to
determine
the
prognostic
significance
of
treatment-induced
pathologic
necrosis
in
patients
receiving
neoadjuvant
chemoradiotherapy
for
STS
.
Between
1989
and
2011
,
a
total
of
113
patients
with
grade
2
or
3
(
graded
according
to
the
National
Cancer
Institute
grading
system
using
3
tiers
)
extremity
or
truncal
STS
were
identified
who
received
neoadjuvant
interdigitated
chemoradiotherapy
according
to
protocol
followed
by
surgery
.
The
extent
of
tumor
necrosis
in
the
resected
specimens
was
quantified
and
correlated
with
outcome
.
The
median
tumor
necrosis
rate
was
90
%
,
and
103
patients
(
91
%
)
received
all
3
cycles
of
planned
neoadjuvant
chemotherapy
.
The
likelihood
of
achieving
≥
95
%
necrosis
was
not
related
to
the
number
of
preoperative
cycles
of
chemotherapy
received
but
was
found
to
be
related
to
tumor
histology
(
62
%
for
malignant
fibrous
histiocytoma
vs
0
%
for
synovial
sarcoma
[
P
<
.
001
]
;
56
%
for
myxoid
liposarcoma
vs
0
%
for
synovial
sarcoma
[
P
 
=
 
.
002
]
)
.
At
a
median
follow-up
of
6
years
,
there
were
no
statistically
significant
differences
noted
in
the
5
-
year
local
control
,
disease-
specific
survival
,
and
overall
survival
rates
for
patients
with
≥
95
%
necrosis
(
50
patients
;
44
%
)
and
<
95
%
necrosis
(
63
patients
;
56
%
)
,
even
when
stratifying
by
histology
.
In
a
homogeneous
population
of
patients
with
high
-grade
extremity
and
truncal
STS
who
were
treated
with
neoadjuvant
chemoradiotherapy
,
the
extent
of
pathologic
tumor
necrosis
did
not
correlate
with
outcome
.
Cancer
2014
;
120
:
3676
-
3682
.
©
2014
American
Cancer
Society
.
Diseases
Validation
Diseases presenting
"statistically significant differences"
symptom
aniridia
classical phenylketonuria
dentinogenesis imperfecta
esophageal carcinoma
esophageal squamous cell carcinoma
familial mediterranean fever
liposarcoma
oculocutaneous albinism
oral submucous fibrosis
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