TY - JOUR
T1 - A moderate dose of preoperative radiotherapy may improve resectability in myxoid liposarcoma
AU - Lansu, Jules
AU - Braam, P. tra M.
AU - van Werkhoven, Erik
AU - Scholten, Astrid N.
AU - Schrage, Yvonne
AU - van Houdt, Winan J.
AU - van Langevelde, Kirsten
AU - Haas, Rick L.
N1 - Funding Information: This research was supported by grants of KWF (8069/KaWeFis Batch 7), Nanobiotix Company, foundation “Honderdduizend Keer een Tientje”, and the European Organization for Research and Treatment of Cancer - Soft Tissue and Bone Sarcoma Group . Publisher Copyright: © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
PY - 2021/10
Y1 - 2021/10
N2 - Background: Histotype specific neoadjuvant therapy response data is scarce in soft tissue sarcomas. This study aimed to assess the impact of a moderate radiotherapy (RT) dose on resectability and to correlate MRI parameters to pathological treatment response in Myxoid Liposarcoma (MLS). Methods: This prospective, multicenter, single-arm, phase 2 trial assessed the radiological effects of 36 Gy of preoperative radiotherapy in primary non-metastatic MLS (n=34). Distance of the tumor to the neurovascular bundle, tumor dimensions, fat fraction, enhancing fraction were determined on MRI scans at baseline, after 8 and 16 fractions, and preoperatively. Pathological response was established by central pathology review. Results: Preoperative radiotherapy resulted in a median increase of 2 mm (IQR 0 to 6) of the distance of the tumor to the neurovascular bundle. As compared to baseline, the median change of the tumor volume, craniocaudal diameter and axial diameter at preoperative MRI were −60% (IQR -74 to -41), −19% (IQR -23 to -7) and −20% (IQR -29 to -12), respectively. The median fat fraction of 0.1 (IQR 0.0–0.1) and enhancing fraction of 0.8 (IQR 0.6 to 0.9) at baseline, changed to 0.2 (IQR 0.1 to 0.5) and to 0.5(IQR 0.4 to 0.9) preoperatively, respectively. Radiological signs of response in terms of volume, enhancing fraction and fat fraction were correlated with specific pathological signs of response like hyalinization, necrosis and fatty maturation. Conclusions: A moderate dose of preoperative radiotherapy may improve resectability in MLS and could facilitate achievement of clear margins and function preservation. MRI features which were predictive for expressions of pathological response, can play a role in further personalization of neoadjuvant treatment strategies in order to improve outcome in MLS.
AB - Background: Histotype specific neoadjuvant therapy response data is scarce in soft tissue sarcomas. This study aimed to assess the impact of a moderate radiotherapy (RT) dose on resectability and to correlate MRI parameters to pathological treatment response in Myxoid Liposarcoma (MLS). Methods: This prospective, multicenter, single-arm, phase 2 trial assessed the radiological effects of 36 Gy of preoperative radiotherapy in primary non-metastatic MLS (n=34). Distance of the tumor to the neurovascular bundle, tumor dimensions, fat fraction, enhancing fraction were determined on MRI scans at baseline, after 8 and 16 fractions, and preoperatively. Pathological response was established by central pathology review. Results: Preoperative radiotherapy resulted in a median increase of 2 mm (IQR 0 to 6) of the distance of the tumor to the neurovascular bundle. As compared to baseline, the median change of the tumor volume, craniocaudal diameter and axial diameter at preoperative MRI were −60% (IQR -74 to -41), −19% (IQR -23 to -7) and −20% (IQR -29 to -12), respectively. The median fat fraction of 0.1 (IQR 0.0–0.1) and enhancing fraction of 0.8 (IQR 0.6 to 0.9) at baseline, changed to 0.2 (IQR 0.1 to 0.5) and to 0.5(IQR 0.4 to 0.9) preoperatively, respectively. Radiological signs of response in terms of volume, enhancing fraction and fat fraction were correlated with specific pathological signs of response like hyalinization, necrosis and fatty maturation. Conclusions: A moderate dose of preoperative radiotherapy may improve resectability in MLS and could facilitate achievement of clear margins and function preservation. MRI features which were predictive for expressions of pathological response, can play a role in further personalization of neoadjuvant treatment strategies in order to improve outcome in MLS.
KW - MRI
KW - Myxoid liposarcoma
KW - Myxoid liposarcomas
KW - Neoadjuvant radiotherapy
KW - Soft tissue sarcoma
KW - Soft tissue sarcomas
UR - http://www.scopus.com/inward/record.url?scp=85109183300&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2021.06.020
DO - https://doi.org/10.1016/j.ejso.2021.06.020
M3 - Article
C2 - 34233858
SN - 0748-7983
VL - 47
SP - 2633
EP - 2639
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
ER -