title: Histological response assessment following neoadjuvant isolated limb perfusion in patients with primary, localised, high-grade soft tissue sarcoma.
abstract: OBJECTIVE
  Histological response assessment following neoadjuvant treatment can help identify patients at a higher risk for systemic disease progression. Our goal was to evaluate whether mitotic count and the amount of viable tumour following neoadjuvant isolated limb perfusion (ILP) for primary, locally advanced, non-metastatic, high-grade extremity soft tissue sarcoma correlate with prognosis.
  
  
  METHODS
  This study is a retrospective analysis of 61 patients who underwent neoadjuvant ILP followed by surgical resection with curative intent between 2001 and 2011. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test.
  
  
  RESULTS
  The median follow-up was 44 months for all patients and 55 months for survivors. The amount of viable tumour after ILP had no correlation with overall (OS) (P = 0.227) or event-free (EFS) (P = 0.238) survival probability. Patients with a low mitotic count after ILP had a significantly higher OS (P < 0.001), EFS (P = 0.002) and post-relapse survival probability (P = 0.030) compared to patients with an intermediate or high mitotic count.
  
  
  CONCLUSIONS
  The mitotic count following ILP for primary, high-grade, locally advanced, non-metastatic soft tissue sarcoma appears to significantly correlate with prognosis. If these results are validated in a prospective setting, they could provide a rationale for the design of adjuvant systemic chemotherapy trials with the goal of improving the prognosis of patients with an intermediate or high mitotic count after ILP.
authors.affiliation: a Department of General Orthopaedics and Tumour Orthopaedics , Münster University Hospital , Münster , Germany .|b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany .
authors.forename: Dimosthenis
authors.initials: D
authors.lastname: Andreou
authors.affiliation: c Department of Pathology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Emil von Behring , Berlin , Germany .
authors.forename: Mathias
authors.initials: M
authors.lastname: Werner
authors.affiliation: d Department of Haematology , Oncology and Palliative Care, Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum , Bad Saarow , Germany .
authors.forename: Daniel
authors.initials: D
authors.lastname: Pink
authors.affiliation: b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany .
authors.forename: Frank
authors.initials: F
authors.lastname: Traub
authors.affiliation: e Department of Internal Medicine II , HELIOS Klinikum Emil von Behring , Berlin , Germany .
authors.forename: Markus K
authors.initials: MK
authors.lastname: Schuler
authors.affiliation: a Department of General Orthopaedics and Tumour Orthopaedics , Münster University Hospital , Münster , Germany .
authors.forename: Georg
authors.initials: G
authors.lastname: Gosheger
authors.affiliation: f Department of Radiology , HELIOS Klinikum Berlin-Buch , Berlin , Germany , and.
authors.forename: Björn
authors.initials: B
authors.lastname: Jobke
authors.affiliation: g Department of Interdisciplinary Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Reichardt
authors.affiliation: b Department of Orthopaedic Oncology , Sarcoma Centre Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch , Berlin , Germany .
authors.forename: Per-Ulf
authors.initials: PU
authors.lastname: Tunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion; D018572:Disease-Free Survival; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012509:Sarcoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan
keywords: Isolated limb perfusion; mitotic count; response assessment; soft tissue sarcoma; viable tumour