OSTEOGENIC SARCOMA: ASSESSMENT OF TUMOR NECROSIS WITH DYNAMIC MR IMAGING AFTER NEOADJUVANT CHEMOTHERAPY - WORK IN PROGRESS

Panicek DM, Dyke JP, Ballon DJ, Koutcher JA, Schwartz LH, Healey JH, Meyers PA, Huvos AG (Memorial Sloan-Kettering Cancer Center, New York, NY 10021).

TREATMENT INDUCED PATHOLOGIC NECROSIS AS A PREDICTOR OF SURVIVAL IN PATIENTS RECEIVING PRE-OPERATIVE THERAPY FOR EXTREMITY SOFT TISSUE SARCOMAS

Eilber FC, Rosen G, Eckardt J, Forscher C, Nelson S, and Eilber FR, UCLA Musculo-Skeletal Group, Los Angeles, CA.

Treatment induced pathologic necrosis has been proven to be a significant predictor of survival in patients receiving pre-operative chemotherapy for bone tumors. However, such a correlation remains uncertain for patients with extremity soft tissue sarcomas. The purpose of this study was to determine if treatment induced pathologic necrosis correlates with disease free and overall survival in patients with extremity soft tissue sarcomas.

From 1975 to 1998 a total of 781 patients with high-grade extremity soft tissue sarcomas were treated at UCLA. Four hundred ninety-six of these patients received protocol, pre-operative therapy with chemotherapy and radiation: 35 patients adriamycin / 3500cG, 134 patients - adriamycin / 1750cG, 109 patients adriamycin / 2800cG, 53 patients - adriamycin, platinum / 2800cG, and 125 patients - adriamycin, platinum, ifosfamide / 2800cG. Pathologic assessment of tumor necrosis was performed in all 496 cases that received pre-operative therapy. One hundred ninety-three of the cases had no tumor assessable due to recent prior excision. The remaining 311 cases had assessable tumor.

The patients with >95% tumor necrosis had a disease free survival of 62% and an overall survival of 88%. In contrast the patients with <95% tumor necrosis had a disease free survival of 47% and an overall survival of only 58% (P=0.001 and p=0.003, respectively). A pathologic response of >95% was achieved in 46% of the assessable cases receiving adriamycin, platinum, ifosfamide / 2800cG, but only in 13% receiving other regimens.

Treatment induced pathologic necrosis is a predictor of survival in patients with extremity soft tissue sarcomas. Patients with a good pathologic response (tumor necrosis >95%) had a significantly improved disease free and overall survival. Ifosfamide has increased the percentage of patients achieving a good pathologic response and further efforts at increasing the number of patients attaining this good response are warranted.