Radiographic response to neoadjuvant therapy and its impact on scope of surgery and prognosis in stage IIB/III soft tissue sarcomas

BACKGROUND: Neoadjuvant chemoradiotherapy has been newly included in the NCCN guidelines as a treatment option for stage IIB/III soft tissue sarcomas. Whether radiographic response to neoadjuvant therapy correlates with improved quality of resection and prognosis remains unproven. METHODS: Data from 120 consecutive patients who were treated with neoadjuvant chemoradiotherapy followed by surgical resection for their locally aggressive limb sarcomas were retrospectively reviewed. Radiographic response was evaluated after neoadjuvant therapy according to Response Evaluation Criteria In Solid Tumors, and data was analyzed for overall survival (OS), local recurrence free survival (LRFS) and metastasis free survival (MFS). Surgical complications and toxicities, as well as functional outcomes, were also analysed. RESULTS: After neoadjuvant chemoradiotherapy, 25 patients (20.8%) had a partial response, 75 patients (62.5%) had stable disease, and 20 patients (16.7%) showed disease progression. Radiographic response to neoadjuvant therapy correlated significantly with improved OS (P = 0.002) and MFS (P < 0.001). Patients with partial response (PR) had a significantly decreased rate of R2 resection as compared with stable disease (SD) and progressive disease (PD) patients (4.0% Vs 21.4%, P < 0.001). CONCLUSIONS: Radiographic response to neoadjuvant chemoradiotherapy correlates with improved quality of resection and prognosis in extremity STS patients.