title: Complete pathologic response to neoadjuvant radiotherapy is predictive of oncological outcome in patients with soft tissue sarcoma.
abstract: We sought to determine if complete pathological necrosis (pathCR) predicts favorable oncological outcome in soft tissue sarcoma (STS) patients receiving pre-operative radiation monotherapy (RT).
  
  
  METHODS
  We evaluated 30 patients with primary STS treated with neoadjuvant RT followed by definitive resection, from 2000 to 2010 at our institution. We defined ≥ 95% tumor necrosis as pathCR.
  
  
  RESULTS
  There were 22 STS of the extremities (73%), 7 of the retroperitoneum (23%), and 1 (4%) of the trunk. The median pathological percentage of tumor necrosis was 35% (range 5-100%) with three tumors (10%) demonstrating pathCR. With a median follow-up of 40 months, the 5-year local recurrence-free survival (LRFS), distant recurrence-free survival (DRFS), and overall survival (OS) for the entire cohort were 100%, 61% ± 11%, and 69% ± 11%, respectively. Among patients with pathCR, 3-year DRFS was 100% compared to 63±11% in patients without pathCR (p=0.28).
  
  
  CONCLUSIONS
  Following neoadjuvant RT for STS, pathCR is associated with a clinically but not statistically significant 37% improvement in 3-year DRFS.
authors.affiliation: Division of Surgical Oncology, University of California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Dhruvil
authors.initials: D
authors.lastname: Shah
authors.forename: Dariusz
authors.initials: D
authors.lastname: Borys
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Chin-Shang
authors.initials: CS
authors.lastname: Li
authors.forename: Robert M
authors.initials: RM
authors.lastname: Tamurian
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
authors.forename: Arta
authors.initials: A
authors.lastname: Monjazeb
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D020360:Neoadjuvant Therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult