Posters— Diagnostic Imaging/Pathology

GOOD PATHOLOGICAL RESPONSE TO NEOADJUVANT CHEMOTHERAPY IN PATIENTS SHOWING CLINICAL OR RADIOLOGICAL PROGRESSION OF DISEASE – 3 CLINCAL CASES

Plummer R, Lucraft H, Murray S, Malcolm A, Dildey P, Grainger A, Baudouin C, Verrill M. (North of England Bone and Soft tissue Tumour Service, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN UK.)

Neoadjuvant chemotherapy has an established role in the treatment of head and neck carcinoma, breast cancer and osteosarcoma. As well as an increase in the limb/breast conservation rate, pathological response to neoadjuvant chemotherapy is an independent prognostic marker in osteosarcoma (1) and breast carcinoma (2). We report three cases of soft tissue sarcoma treated with neoadjuvant chemotherapy.

Case 1: a 50 year old man presented with malignant fibrous histiocytoma of the right thigh. After two cycles of neoadjuvant doxorubicin (75mgm-2), there was clinical and radiological disease progression, and he proceeded to immediate surgery. There was 90% tumour cell necrosis in the operative tumour specimen. Further doxorubicin was given as adjuvant therapy.

Case 2: a 47 year old woman presented with a high grade liposarcoma of the right thigh. She received one cycle of neoadjuvant doxorubicin (75mgm-2). There was clinical progression of the primary tumour, and she went forward to surgery immediately. A high degree of tumour necrosis was seen in the pathological specimen.

Case 3: a 44 year old man presented with a right thigh high grade malignant fibrous histiocytoma. He received three cycles of ifosfamide (5gm-2)/adriamycin (50mgm-2). MRI scan showed enlargement of the tumour, with central necrosis. The surgical pathological specimen showed evidence of chemotherapeutic damage with scattered tumour cells in a background of reactive collagen and extensive haemorrhage.

Each of these patients received pre-operative chemotherapy with the aim of enabling limb conservation. In each case there was clinical and/or radiological disease progression within three cycles of chemotherapy and patients had early surgery. Histologic examination of each operative specimen revealed extensive tumour cell necrosis.

These favourable pathological responses were at odds with the clinical and radiological evidence of progressive disease by standard response criteria. Two of these patients were in clinical trials of chemotherapy and were recorded to have progressive disease when there was clearly an antitumour effect. In cases of early progression of a primary soft tissue sarcoma on chemotherapy, we recommend that investigators should consider either biopsy or dynamic gadolinium enhanced MRI scanning to detect pathological responses, which are unexpected on clinical and conventional radiological assessment

1. Davis A.M. Bell R.S. Goodwin P.J. Prognostic factors in osteosarcoma: a critical review. Journal of Clinical Oncology 12(2) 423-431, 1994.
2. Fisher B, Bryant J, Wolmark N, Namounas E, Brown A, Fisher ER, Wickerham DL. Effect of preoperative chem