Effect of Neoadjuvant Therapies on Soft Tissue Sarcomas with Tail-like Lesions: A Multicenter Retrospective Study.

Hisaki Aiba,Yoji Shido,Kenji Yamada,Junji Wasa,Kunihiro Ikuta,Takao Sakai,Hideki Murakami,Eiji Kozawa,Yoshihiro Nishida,Tomohisa Sakai,Hiroaki Kimura,Akihito Nagano,Tomoki Nakamura,Katsuhisa Kawanami,Daisuke Ishimura,Akihiko Matsumine,Kunihiro Asanuma,Satoshi Tsukushi

doi:10.3390/cancers13153901

Abstract

Simple SummaryIt is essential to focus on the tumor invasive front (tail-like lesion)—the soft tissue sarcoma’s specific peripheral infiltrative growth characteristics—to avoid leaving unexpected tumor residues during surgery. This study aimed to analyze the effect of neoadjuvant therapy for highly malignant soft tissue tumors with tail-like lesions. From 2012 to 2019, 36 patients were treated with neoadjuvant therapy, including chemotherapy, radiotherapy, or both. Consequently, we observed shrinkage, and occasionally the disappearance of the tail-like lesion. The lesion’s regression was related to the necrosis rate of the main part of the tumor. However, the regression of lesions was not directly related to the achievement of surgery with a microscopically negative margin or improvements of oncological outcomes. Thus, a more multi-angle evaluation to elaborate surgical strategy is necessary.Several types of soft tissue sarcomas have peripheral infiltrative growth characteristics called tail-like lesions. The efficacy of neoadjuvant therapy for tumors with tail-like lesions has not been elucidated. From 2012 to 2019, we analyzed 36 patients with soft tissue sarcoma with tail-like lesions treated with neoadjuvant therapy, including chemotherapy, radiotherapy, or both. The effect of neoadjuvant therapy on the tail sign was investigated by analyzing the change in tail-like lesions during neoadjuvant therapy and histological responses. The median length of the tail-like lesion reduced from 29.5 mm at initiation to 19.5 mm after neoadjuvant therapy. The extent of shrinkage in tail-like lesions was related to the histopathological responses in the main part of the tumor. Complete disappearance of the tail-like lesion was observed in 12 patients; however, it was not related to achieving a microscopically negative margin. The oncologic outcomes did not significantly differ between cases with and without the complete disappearance of tail-like lesions. This study indicated that the shrinkage of tail-like lesions did not have a significant effect on complete resection or improvements of clinical outcomes. A more comprehensive evaluation is needed to elaborate on the surgical strategy.

Highlights

Soft tissue sarcomas are rare and heterogeneous entities with local or distant metastatic potential [1]
The tumors were classified as undifferentiated pleomorphic sarcoma (UPS, n = 11), myxofibrosarcoma (MFS, n = 13), synovial sarcoma (SS, n = 4), dedifferentiated liposarcoma (DDL, n = 4), and others
We evaluated the actual effect of neoadjuvant therapy in tail-like lesions and proved the relationship between histological responses in the main tumor lesion and regression of the tail-like lesion

Summary

Introduction

Soft tissue sarcomas are rare and heterogeneous entities with local or distant metastatic potential [1]. 10–30% of patients experience local recurrences, complicating subsequent procedures and occasionally resulting in amputation [2]. Several soft tissue sarcoma types have peripheral infiltrative growth characteristics around the invasive fronts (tail-like lesions) [3,4]. The surgical intervention plan should include these reactive zones during complete resection [5,6]. Neoadjuvant therapy using radiotherapy, chemotherapy, or both is considered, especially for locally advanced tumors, to improve resectability with appropriate margins and long-term oncologic outcomes.

Objectives

Methods

Results

Conclusion