title: Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas.
abstract: BACKGROUND
  Downstaging of large soft tissue sarcomas can be accomplished by the use of neoadjuvant chemotherapy (NeoCT). The authors tested the hypothesis that radiographic response to NeoCT predicts improved local control and survival.
  
  
  METHODS
  The authors reviewed the medical records of 65 patients with Stage II or III soft tissue sarcoma (42 extremity, 23 retroperitoneal) who were treated with doxorubicin or ifosfamide-based NeoCT from January 1991 to December 1996. Radiographic response and impact on surgical therapy were determined retrospectively by comparing imaging studies obtained before and after chemotherapy.
  
  
  RESULTS
  The radiographic responses observed were partial response (PR; 22 patients [34%]); minor response (MR; 6 patients [9%]); stable disease (20 patients [31%]); and progressive disease (17 patients [26%]). Downstaging sufficient to decrease the scope of the operation occurred in 13% of the patients, 78% had no change, and 9% had disease progression sufficient to increase the scope of the operation. Patients having any radiographic response (PR or MR) had a higher margin-negative resection rate, a better local recurrence-free survival rate, and a better overall survival rate than did nonresponders.
  
  
  CONCLUSIONS
  The NeoCT regimens used in this study resulted in tumor shrinkage sufficient to impact surgical therapy in a few patients. However, radiographic response predicted improved local control and overall survival rate.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: Funda
authors.initials: F
authors.lastname: Meric
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Hess
authors.forename: Datla G K
authors.initials: DG
authors.lastname: Varma
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Kresimira M
authors.initials: KM
authors.lastname: Milas
authors.forename: Shreyaskumar R
authors.initials: SR
authors.lastname: Patel
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.forename: Carl
authors.initials: C
authors.lastname: Plager
authors.forename: Nicholas E J
authors.initials: NE
authors.lastname: Papadopoulos
authors.forename: Michael A
authors.initials: MA
authors.lastname: Burgess
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016019:Survival Analysis