Response to preoperative chemotherapy in patients undergoing resection of pulmonary metastasis from soft tissue sarcoma – a predictor of outcome?

Abstract

Approximately 50% of patients with high-grade soft tissue sarcoma (STS) will develop pulmonary metastasis. This is the most frequent cause of death and improving treatment is warranted. Preoperative chemotherapy is used for selected patients, usually those with less favorable prognosis and mainly outside clinical trials. The predicted value of histological and radiological response to preoperative chemotherapy on outcome was the main focus for this investigation.

Patients and methods. This retrospective study comprises 93 patients with metachronous lung metastasis from STS who underwent complete metastasectomy alone (n = 41) or metastasectomy following preoperative chemotherapy (n = 52). Clinical data, histological and radiological responses to chemotherapy were recorded and survival analyses performed.

Results. The time from initial STS diagnosis to the appearance of metastasis was shorter in the preoperative chemotherapy group than in those treated with surgery alone (p = 0.02). However, no statistical differences in post-metastasis disease-specific survival (DSS) or progression-free survival (PFS) between the groups were demonstrated. Patients in the preoperative chemotherapy group with good (complete) histological response had improved PFS compared with poor responders (p = 0.04). Radiological partial response was an independent, favorable prognostic factor for improved PFS and DSS (p = 0.003).

Conclusion. Despite having unfavorable disease characteristics, some patients may benefit from preoperative chemotherapy. Both histological and radiological responses to preoperative chemotherapy seem to be prognostic in STS patients undergoing complete pulmonary metastasectomy.

Acknowledgments

We thank Liv Aagedal and Trine Thoresen, The Norwegian Radium Hospital, for accurate updating the institution's Sarcoma Database, Dr. Wenche Reed and Unni Haakenaasen, The Norwegian Radium Hospital, for skillful pathological and radiological evaluation at the outset of this study and Dr. Are H. Pripp, Center for Biostatistics and Epidemiology, Oslo University Hospital, for statistical advice. The work was supported by the Norwegian Cancer Society and donations to the Norwegian Radium Hospital.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.