Complete tumor necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing sarcoma

Calderón, Santiago A. Lozano; Albergo, José I.; Groot, Olivier Q.; Merchan, Nelson; Abiad, Jad M. El; Salinas, Vanessa; Mier, Luis Carlos Gómez; Montoya, Camilo Soto; Ferrone, Marco; Ready, John E.; Linares, Francisco J; Levin, Adam S.; Pensado, Manuel Peleteiro; Kreilinger, José Juan Pozo; Ruiz, Irene Barrientos; Ortiz‐Cruz, Eduardo J.; Gebhardt, Mark C.; Coté, Gregory M.; Choy, Edwin; Spentzos, Dimitrios; Hung, Yin P.; Chebib, Ivan; McCulloch, Robert E.; Farfalli, Germán L.; Tinao, Luis Aponte; Morris, Carol D.; Nielsen, G. Petur; Anderson, Megan E.; Jeys, Lee

doi:10.1002/cncr.34506

Cited by 9 publications

(5 citation statements)

References 24 publications

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“…Not surprisingly, data on the tumor necrosis percentage in STS in relation to clinical outcomes are contradictory [18,20]. The data obtained in this study support the conclusion that, in contrast to bone sarcomas, tumor necrosis has no clear prognostic value in MFS [19,34].…”

Section: Discussionsupporting

confidence: 43%

“…Recently, neoadjuvant radiotherapy has been replacing adjuvant radiotherapy as the preferred treatment modality, as it enables more accurate definition of the treatment field and thus limits damage to adjacent structures [14,15]. The role of nRT has been investigated in different histological subtypes of STS, but not in MFS, where positive surgical margins and high tumor necrosis have been identified as predictors for worse clinical outcome [16][17][18][19][20][21]. A high percentage of tumor necrosis, histologically assessed, after nRT is the most commonly used surrogate marker for treatment response; however, this has not been validated in STS and small studies present conflicting data [18][19][20]22].…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy

van Ravensteijn,

Nederkoorn,

Wal

et al. 2023

Cancers

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To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56–21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91–48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39–35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT.

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Section: Discussionsupporting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy

van Ravensteijn,

Nederkoorn,

Wal

et al. 2023

Cancers

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“…13 Our analysis also supports previous data suggesting that categorizing tumors as NVT versus AVT may be a better discriminator of outcome. 14,15 The outstanding outcomes for patients with NVT who received ICC should be explored in future studies.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Patients With Localized Ewing Sarcoma Treated With Interval-Compressed Chemotherapy on Children's Oncology Group Study AEWS0031

Cash,

Krailo,

Buxton

et al. 2023

JCO

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Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned coprimary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. Long-term outcomes from Children's Oncology Group study AEWS0031 were assessed to determine whether the survival advantage of interval-compressed chemotherapy (ICC) was maintained over 10 years in patients with localized Ewing sarcoma (ES). AEWS0031 enrolled 568 eligible patients. Patients were randomly assigned to receive vincristine-doxorubicin-cyclophosphamide and ifosfamide-etoposide alternating once every 3 weeks (standard timing chemotherapy [STC]) versus once every 2 weeks (ICC). For this updated report, one patient was excluded because of uncertainty of original diagnosis. The 10-year event-free survival (EFS) was 70% with ICC compared with 61% with STC ( P = .03), and 10-year overall survival (OS) was 76% with ICC compared with 69% with STC ( P = .04). There was no difference in the 10-year cumulative incidence of second malignant neoplasms (SMNs; PC [see Data Supplement, online only] = .5). A test for interaction demonstrated that ICC provided greater risk reduction for patients with tumor volume ≥200 mL than for patients with tumors <200 mL, but no evidence for a significant interaction in other subgroups defined by age, primary site, and histologic response. With longer-term follow-up, ICC for localized ES is associated with superior EFS and OS without an increased risk for SMN compared with STC. ICC is associated with improved outcomes even in adverse-risk patient groups.

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“…A study from Boston (Massachusetts, USA) included 427 patients who had Ewing’s sarcoma or family lesions and underwent preoperative chemotherapy followed by surgery at one of ten institutions. 1 After controlling for clinical factors identified in bivariate analysis (including age, tumour volume, location, surgical margins, metastatic disease at presentation, and preoperative radiotherapy), patients who had a complete (100%) tumour response to chemotherapy had increased overall survival, recurrence-free survival, metastasis-free survival, and event-free survival when compared with patients who had a partial response (0% to 99%). The authors concluded that complete tumour necrosis should be the index parameter to grade response to treatment as satisfactory in patients with Ewing’s sarcoma.…”

Section: Complete Tumour Necrosis After Neoadjuvant Chemotherapy Defi...mentioning

confidence: 97%

Oncology

2023

Bone &Amp; Joint 360

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The April 2023 Oncology Roundup360 looks at: Complete tumour necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing’s sarcoma; Monitoring vascularized fibular autograft: are radiographs enough?; Examining patient perspectives on sarcoma surveillance; The management of sacral tumours; Venous thromboembolism and major bleeding in the clinical course of osteosarcoma and Ewing’s sarcoma; Secondary malignancies after Ewing’s sarcoma: what is the disease burden?; Outcomes of distal radial endoprostheses for tumour reconstruction: a single centre experience over 15 years; Is anaerobic coverage during soft-tissue sarcoma resection needed?; Is anaerobic coverage during soft-tissue sarcoma resection needed?

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Complete tumor necrosis after neoadjuvant chemotherapy defines good responders in patients with Ewing sarcoma

Cited by 9 publications

References 24 publications

The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy

The Prognostic Relevance of MRI Characteristics in Myxofibrosarcoma Patients Treated with Neoadjuvant Radiotherapy

Long-Term Outcomes in Patients With Localized Ewing Sarcoma Treated With Interval-Compressed Chemotherapy on Children's Oncology Group Study AEWS0031

Oncology

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