Treatment-induced pathologic necrosis: A predictor of local recurrence andsurvival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas

Purpose: To determine whether treatment-induced pathologic necrosis correla tes with local recurrence and overall survival in patients who receive neoa djuvant therapy for high-grade extremity soft tissue sarcomas. Patients and Methods: Four hundred ninety-six patients with intermediate- t o high-grade extremity soft tissue sarcomas received protocol neoadjuvant t herapy. All patients underwent surgical resection after neoadjuvant therapy and had pathologic assessment of rumor necrosis in the resected specimens. Results: The 5- and 10-year local recurrence rates for patients with greate r than or equal to 95% pathologic necrosis were significantly lower (6% and 11%, respectively) than the local recurrence rates for patients with less than 95% pathologic necrosis (17% and 23%, respectively). The 5- and 10-yea r survival rates for the patients with a 95% pathologic necrosis were signi ficantly higher (80% and 71%, respectively) than the survival rates for the patients with less than 95% pathologic necrosis (62% and 55%, respectively ). Patients with less than 95% pathologic necrosis were 2.51 times more lik ely to develop a local recurrence and 1.86 times more likely to die of thei r disease as compared with patients with greater than or equal to 95% patho logic necrosis. The percentage of patients who achieved greater than or equ al to 95% pathologic necrosis increased to 48% with the addition of ifosfam ide as compared with 13% of the patients in all the other protocols combine d. Conclusion: Treatment-induced pathologic necrosis is an independent predict or of both local recurrence and overall survival in patients who receive ne oadjuvant therapy for high-grade extremity soft tissue sarcomas. A complete pathologic response (greater than or equal to 95% pathologic necrosis) cor related with a significantly lower rate of lacal recurrence and improved ov erall survival. (C) 2001 by American Society of Clinical Oncology.