Survival In Soft Tissue Sarcoma Research Articles

Accreditation for centers of sarcoma surgery.

Soft-tissue sarcomas (STS) are a heterogeneous group of neoplasms which may be subclassified into over 70 specific histologies and may be distributed throughout the body. Approximately one-half arises in the extremities and one-third arises in the abdomen, pelvis, and retroperitoneum. The diversity and rarity of sarcomas combined with the quite large number of affected patients are factors which underline of the importance of networking in diagnosis, therapy, and research dealing with rare cancers. The expertise of the treating center is one of the most significant factors affecting survival in STS. The optimal treatment of locally recurrent disease is to prevent it; aggressive multidisciplinary treatment of the primary diseaseis thus required, as adjuvant therapies cannot compensate for inadequate surgery. Treatment within specialized multidisciplinary teams (MDTs) is crucial; a body of expertise in all the areas of diagnosis and treatment is required to manage STS appropriately. Conformity to approved treatment guidelines is improved when patients are treated by an MDT in a reference centre. Traditionally, peer-reviewed literature has discussed the surgical management of STS based on the site of origin. While the site of origin remains an important consideration, it has become increasingly clear that surgery must also be tailored to specific sarcoma histology to more accurately reflect tumor biology and pattern of recurrence. All sarcoma operations, included retroperitoneal surgery, should be performed in specialized centres to ensure optimal outcomes.

Epidemiological study of soft-tissue sarcomas in Ireland.

Soft-tissue sarcomas (STS) account for 1% of adult and 7% of pediatric malignancies. Histopathology and classification of these rare tumors requires further refinements. The aim of this paper is to describe the current incidence and survival of STS from 1994 to 2012 in Ireland and compare these with comparably coded international published reports. This is a retrospective, population study based on the data from the National Cancer Registry of Ireland (NCRI). Incidence and relative survival rates for STS in Ireland were generated. Incidence of STS based on gender, age and anatomical location was examined. Annual mean incidence rate (European Age Standardized) in Ireland between 1994 and 2012 was 4.48 ± 0.15 per 100,000 person-years. The overall relative 5-year survival rate of STS for the period 1994-2011 in Ireland was 56%, which was similar to that reported in the U.K. but lower than in most of Europe and U.S.A. Survival rate fluctuated over the period examined, declining slightly in females but showing an increase in males. STS incidence trends in Ireland were comparable to international reports. Survival trends of STS were significantly different between Ireland and other European countries, requiring further study to understand causation.

Association of Short Duration From Initial Symptoms to Specialist Consultation With Poor Survival in Soft-Tissue Sarcomas

The association of symptom duration with survival remains controversial in soft-tissue sarcoma (STS). We determined whether the length from initial symptoms to specialist consultation affects prognosis in STSs. We retrospectively reviewed 152 primary STS patients (with 142 non-small round cell sarcomas) who consulted our specialist hospital. The factors that affected the length of the period from the initial symptoms to specialist consultation and the length of the delay at the clinic before specialist hospital referral were investigated. The relation between the length of the period from symptom onset and overall survival was also analyzed. Unplanned excision and superficial tumor were significantly associated with increasing duration from the initial symptoms to specialist hospital referral. Multivariate analysis revealed that tumors over 5 cm (P=0.002 and 0.005) and symptoms within 6 months (P=0.017 and 0.016) were independent poor prognostic factors of overall survival among the pretreatment factors when analyzing all and non-small round cell STSs. This is a first report to show the independent prognostic role of symptom duration in STSs on multivariate analysis. Considering the impact of symptom duration on survival in these heterogenous tumors, careful follow-up and consideration of treatment are necessary for patients with short symptom duration.

VEGFR2 predicts decreased patients survival in soft tissue sarcomas

AimsTyrosine kinases are promising targets for personalized medicine, and new drugs are currently in phase 2 and phase 3 clinical trials. However, expression analysis of tyrosine kinases as predictive biomarkers is still not a standard approach. Furthermore, only limited studies have investigated the expression of tyrosine kinase receptors on the protein level. In this study, we analysed a well-characterised group of soft tissue sarcomas for different tyrosine kinase receptors and correlated the results with clinicopathological parameters, including survival. Methods275 soft tissue sarcomas of our Sarcoma center at the Ludwig-Maximilians-University (LMU) were reinvestigated and categorized according to the current WHO classification system. The tumor collective included undifferentiated pleomorphic sarcomas (n=81), leiomyosarcomas (n=50), synovial sarcomas (n=27), liposarcomas (n=51), angiosarcomas (n=43) and other soft tissue sarcomas (n=23). ResultsOn protein levels, high expression of VEGFR1 was detected immunohistochemically in 61%, VEGFR2 (KDR) in 11%, VEGFR3 in 64%, PDGFRA in 42% and PDGFRB in 73%. High expression of VEGFR1-3 and PDGFRB was significantly correlated with higher grading (G2 vs G3, p<0.05), and high VEGFR2 was significantly correlated with decreased patients’ survival (p<0.001). ConclusionsTyrosine kinase receptors showed a distinct expression pattern in soft tissue sarcomas. High expression of VEGFR2 (KDR) is significantly associated with decreased patients’ survival. High VEGFR 1-3 and PDGFRB are significantly correlated with higher tumor grading. Protein signatures might be evaluated before targeted therapy to give a rationale for an eligible personalized therapy.

Effect of marital status on treatment and survival of extremity soft tissue sarcoma.

Spousal support has been hypothesized as providing important psychosocial support for patients and as such has been noted to provide a survival advantage in a number of chronic diseases and cancers. However, the specific effect of marital status on survival in soft tissue sarcomas (STSs) of the extremity has not been explored in detail. A total of 7384 patients were evaluated for this study using a Surveillance, Epidemiology, and End Results (SEER) registry query for patients over 20 years old with extremity STS diagnosed between 2004 and 2009. Survival outcomes were analyzed using Gray's test after patients were stratified by marital status. The Fine and Gray model, a multivariable regression model, was used to assess whether marital status was an independent predictor of sarcoma specific death. Statistical significance was maintained at P < 0.05. Analysis of the SEER database showed that single patients were more likely to die of their STS and at a faster rate than married patients. No differences were noted in tumor size and tumor site on presentation between married and single patients. However, single patients presented with higher grade tumors more frequently (P = 0.013), received less radiotherapy (P < 0.001), and had less surgery carried out (P < 0.001), compared with their married peers. Regression analysis showed that after accounting for tumor size, grade, site, histology, use of radiotherapy, age, gender, region where the patients were from, and income, being single continued to serve as an independent predictor of sarcoma-specific death; P < 0.0001. Overall survival is worse for single patients, when compared with married patients, with STS. Single patients do not undergo surgical resection or receive radiation therapy as frequently as their married counterparts. Social support systems and barriers to care should be evaluated at time of diagnosis and addressed in single patients to potentially improve survival outcomes.

Socio-economic Factors Affect the Outcome of Soft Tissue Sarcoma: an Analysis of SEER Data

This study analyzed whether socio-economic factors affect the cause specific survival of soft tissue sarcoma (STS). Surveillance, Epidemiology and End Results (SEER) soft tissue sarcoma (STS) data were used to identify potential socio-economic disparities in outcome. Time to cause specific death was computed with Kaplan-Meier analysis. Kolmogorov-Smirnov tests and Cox proportional hazard analysis were used for univariate and multivariate tests, respectively. The areas under the receiver operating curve were computed for predictors for comparison. There were 42,016 patients diagnosed STS from 1973 to 2009. The mean follow up time (S.D.) was 66.6 (81.3) months. Stage, site, grade were significant predictors by univariate tests. Race and rural-urban residence were also important predictors of outcome. These five factors were all statistically significant with Cox analysis. Rural and African-American patients had a 3-4% disadvantage in cause specific survival. Socio-economic factors influence cause specific survival of soft tissue sarcoma. Ensuring access to cancer care may eliminate the outcome disparities.

Correlation of Oncologic Long-Term Results and Genetic Instability in Soft Tissue Sarcomas

Purpose: Soft tissue sarcomas (STS) represent a heterotop group of tumours. Microsatellite instabilities (MSI) and loss of heterozygosity (LOH) as phenomena of a genetic instability should be analysed in STS and correlated with the long-term oncologic outcome. Methods: Patients treated for a STS with a follow-up of at least 10 years were included. Thus, 86 patients (mean age 50.5 years, range 16-86 years) treated for a STS between 1993 and 2000 were routinely controlled every 6 months. Incidence of local recurrences, distant metastases, and overall survival were analysed. Sixty-six tumour samples were available for microsatellite analysis using the former traditional method of PCR amplification at 6 loci in the neighbourhood of hMSH2, hMLH1, p53, p16, rb1, and hTR. Results: There were 30 low-grade and 56 high-grade sarcomas. The mean follow-up was 144 months (120-192 months). Twenty-nine patients died of their disease. Local recurrences were seen in 13 patients, whereas metastases were noticed in 23 patients. The overall survival was dependent on the tumour stage (p<0.05), whereas the local tumour control (incidence of local recurrence) was influenced by the surgical margin achieved (p<0.05). The molecular biologic findings revealed 67% of the investigated loci as informative. MSI was found in 6.8% of the informative loci, whereas LOH in 18.8%, respectively. LOH was present in high-grade tumours in 23.8%, whereas in 1.7% in low-grade tumours. In high-grade sarcomas, the 5-year and 10-year survival probabilities were significantly lower in LOH-positive tumours (48.6% and 38%) than in LOH-negative tumours (72.5% and 62%). Conclusion: The overall survival in soft tissue sarcoma is mainly influenced by the tumour stage. In high-grade sarcomas, the survival rate will drop even after 5 years. The detection of loss of heterozygosity represents a negative prognostic predictor in high-grade sarcomas. Microsatellite instability is a rare phenomenon supposing no relevance in the oncogenesis and tumour progression of soft tissue sarcomas.

Elevated Preoperative Systemic Inflammatory Markers Predict Poor Outcome in Localized Soft Tissue Sarcoma

Systemic inflammation has been implicated in cancer development and progression. This study sought to determine whether systemic inflammatory markers can predict postoperative outcome in soft tissue sarcoma (STS). A total of 162 cases of primary, localized STS were reviewed. Patients with evidence of infectious or inflammatory diseases were excluded. The mean follow-up period was 46.7 months. The level of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR) measured before surgery were evaluated for association with disease-specific survival and local recurrence. The mean values of CRP, ESR, and NLR were 0.79 mg/dL, 18.8 mm/h, and 2.12, respectively. Cutoff values derived from receiver-operating characteristic curve analysis were 0.20 mg/dL for CRP, 10.0 mm/h for ESR, and 2.50 for NLR. On univariate analysis, all inflammatory markers were associated with disease-specific survival (CRP: P = 0.007; ESR: P = 0.022; NLR: P = 0.030). On multivariate analysis, the CRP level (P = 0.019) and ESR (P = 0.013) remained significant. Elevation of multiple markers was a more significant prognostic factor than elevation of a single marker (P = 0.001). However, none of the inflammatory markers was associated with local recurrence (CRP: P = 0.345; ESR: P = 0.271; NLR: P = 0.570). Histologic grade was strongly correlated with inflammatory marker values (NLR: P < 0.001; ESR: P = 0.002; CRP: P = 0.007). Preoperative systemic inflammatory status, assessed by using multiple serum markers, predicted disease-specific survival in STS.

Amputation for extremity soft tissue sarcoma does not increase overall survival: A retrospective cohort study

To determine if amputation increases survival when compared to limb salvage surgery in patients with a soft tissue sarcoma (STS) of the extremity when there is often a misconception among physicians and patients that ablative surgery eliminates local recurrence and increases overall survival. This retrospective cohort study assessed 278 patients with STS and compared 18 patients who had undergone amputations for soft tissue sarcomas of the extremities to a comparative cohort of 260 patients who underwent limb salvage surgery during the same time period. Our limb salvage surgery (LSS) rate was 94% overall for soft tissue sarcomas with a median follow-up of 3.1 years. Patients undergoing amputations either had tumors that involved a critical neurovascular bundle (in particular nerve rather than vessel resection was more responsible for a decision toward ablation), or underlying bone or had neoplasms whose large size would require such an enormous resection that a functional limb would not remain. In comparing prognostic effects, mainly death due to sarcoma, distant metastasis and local recurrence, it was found that there was no statistically significant difference between patients undergoing amputation to those undergoing limb salvage surgery (p > 0.05). While amputations do not increase overall survival in soft tissue sarcomas of the extremity as compared to LSS, they are still a valuable option in a surgeon's arsenal. In particular, amputations can provide improved local control and symptomatic treatment in patients who might not be candidates for limb salvage surgery.

18f-FDG-PET imaging as an early survival predictor in patients with high-grade soft tissue sarcomas undergoing neoadjuvant therapy.

10012 Background: Neoadjuvant therapy is associated with considerable toxicity and limited survival benefits in patients with soft tissue sarcoma (STS). We prospectively evaluated whether 18F-FDG PET/CT (PET) imaging after the initial cycle and after end of neoadjuvant therapy could predict overall survival in these patients. Methods: 76 patients (primary STS: n=57; metastatic disease: n=19) with high grade STS were included in this study. PET was performed prior to (n=76), after one cycle (n=52) and after the end of neoadjuvant therapy (n=74). Overall survival was correlated with changes of SUVpeak, RECIST, histopathological response and other parameters predictive of STS survival. Results: One-, two- and five- year survival rates were 95±3.0%, 86±4.6% and 68±6.6% for primary STS. Corresponding one- and two- year survival rates for recurrent/metastatic STS were 77±10.0% and 47±12.1%. Optimal cut-off for early decreases in SUV peak were significant predictors of survival in log-rank test (p=0.027 and p=0.043). However, late decreases in SUV peak were only predictive in primary STS (SUV peak decrease 57%; p=0.035) but not in recurrent/metastatic STS (SUV peak decrease 52%; p=0.057). In primary STS, 7/15 early PET non-responders but only 4/24 early PET responders died during follow up (p=0.068). Conclusions: 18F-FDG-PET seems feasible to predict survival after the initial cycle of neoadjuvant chemotherapy in both patients with primary STS and recurrent/metastatic STS and can potentially serve as an intermediate endpoint biomarker in clinical research and patient care.

Negative Resection Margins are Associated with Recurrence Free Survival in Soft Tissue Sarcomas of the Hand: Level 4 Evidence

Negative Resection Margins are Associated with Recurrence Free Survival in Soft Tissue Sarcomas of the Hand: Level 4 Evidence

Do Surgical Margin and Local Recurrence Influence Survival in Soft Tissue Sarcomas?

Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years). The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities.

Interaction of histologic type and grade in predicting survival from soft tissue sarcoma

10530 Background: Histologic grade has traditionally been considered the paramount prognostic factor in predicting survival for soft tissue sarcoma (STS). We hypothesized that histologic type modifies the prognostic effect of grade. Methods: Utilizing the population- based California Cancer Registry, we identified 8,740 cases of STS diagnosed between 1994 and 2003. Grade was categorized according to the ICD-O-3 five-level system (1 = well differentiated, 2 = moderately differentiated, 3 = poorly differentiated, 4 = undifferentiated/anaplastic, 9 = unknown). Using survival as the outcome variable, grade and histologic type were grouped into three categories, respectively, based on non- overlapping 95% confidence intervals (low, intermediate, and high for grade and favorable, neutral, and unfavorable for histologic type). Because there was a significant interaction between grade and histologic type, we examined the effect of grade within categories of histologic type, and the effect of histologic type within categories of grade. Five-year actuarial disease-specific survival was estimated using the Kaplan- Meier method. Results: Among 114 histologic types, malignant fibrous histiocytoma (20.8%), leiomyosarcoma NOS (12.4%), sarcoma NOS (7.0%), and myxoid liposarcoma (5.3%) were the most prevalent. Sixty-eight histologies were diagnosed in 20 patients or fewer (0.2%). Grade distribution was as follows: 1, 9.9%; 2, 15.1%; 3, 11.6%; 4, 23.8%; and 9, 39.6%. Five-year survival was 25.3% higher for patients with low versus high grade tumors (95.1% versus 69.8%). However, within each grade category, there was a statistically significant gradient of survival associated with histologic type. In the low grade category, survival was 20.2% higher for favorable versus unfavorable types (97.0% versus 76.8%). In the intermediate grade category, survival was 5.6% higher for favorable versus unfavorable types (91.4% versus 85.8%). In the high grade category, survival was 36.7% higher for favorable versus unfavorable types (89.3% versus 52.6%). Conclusions: Histologic type modifies the effect of grade in survival from STS. Within each grade category, there are significant differences in survival based on histologic type. Histologic type is an important predictor of biologic behavior in STS. No significant financial relationships to disclose.

Cryoablation and Resection Influences Patient Survival for Soft Tissue Sarcomas: Impact on Survivorship and Local Recurrence

Cryoablation and Resection Influences Patient Survival for Soft Tissue Sarcomas: Impact on Survivorship and Local Recurrence

The Effect of Systemic Treatment on Patient Survival of Soft-tissue Sarcoma

The Effect of Systemic Treatment on Patient Survival of Soft-tissue Sarcoma

Retrospective analysis of the impact of symptom duration on prognosis in soft tissue sarcoma

The objective was to assess whether time to diagnosis is influenced by patient/tumour-related factors and whether or not duration of symptoms has any impact on survival in soft tissue sarcoma. The study was an analysis of prospectively collected data for patients treated at our centre over a 20-year period. Risk factors were assessed by Kaplan-Meier analysis and the Cox proportional hazards model. Of 1,508 patients, 159 had metastatic disease at diagnosis and were excluded from analyses. In the remaining 1,349 patients overall 5-year survival was 60%. Duration of symptoms had a significant impact on survival (p=0.0037) with each additional week of symptoms reducing the monthly hazard rate by 0.2%. Patient and tumour-related factors significantly associated with longer symptom duration were low-grade, subcutaneous tumours, and epithelioid or synovial sarcoma. Symptom duration was not associated with age/gender or tumour size. Patients with long symptom durations tend to have low-grade disease and a more favourable outcome than patients who experience short symptom durations.

Anatomic location does not impact survival in soft tissue sarcoma of the extremity

9056 Background: Various prognostic factors are known to influence outcome of soft tissue sarcomas. Although anatomic location of extremity sarcoma as a prognostic factor is debatable, several studies suggest lower extremity sarcoma have a worse outcome than upper extremity sarcoma. The aims of the current study were to evaluate overall survival (OS) and disease-free survival (DFS) of soft tissue sarcomas located in the extremity, and test the prognostic value of a series of clinicopathological parameters. Methods: A Retrospective review was undertaken to identify patients with sarcoma located in the extremities. All patients received their primary surgical treatment in our department between January 1991 and December 2001. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and Cox regression. Results: Of the 134 patients identified, 99 patients had lower extremity sarcoma and 35 patients had upper extremity sarcoma. No differences in size, stage or adjuvant therapy were identified between upper and lower extremity sarcomas (p=.11, p=.22 and p=.24, respectively). Mean age was 50 years. Median follow-up was 27 months (range 1–116 months). By univariate analysis, stage, size, and adjuvant therapy of the primary tumor were associated with a decreased in both OS (p<.05) and DFS (p<.05). Age 50 years or greater influenced OS (p<.001) but not DFS (p=.21). Histology of the primary tumor did not effect OS (p=.21) but tended to effect DFS (p<.001). Anatomic location and gender did not significantly influence OS or DFS. By multivariate Cox regression, only adjuvant therapy effected DFS (p=.002). Age, gender, histology, size, stage, and adjuvant therapy did not significantly influence DFS. Overall-survival was influenced by age, histology, stage, and adjuvant therapy. Anatomic location did not have an effect on OS (p=.17) or DFS (p=.99). Conclusion: Location of the primary site of extremity sarcoma does not influence overall survival and disease-free survival. Patients with upper extremity sarcoma do not have a worse outcome than patients with lower extremity sarcoma. No significant financial relationships to disclose.

Anatomic location does not impact survival in soft tissue sarcoma of the extremity

9056 Background: Various prognostic factors are known to influence outcome of soft tissue sarcomas. Although anatomic location of extremity sarcoma as a prognostic factor is debatable, several studies suggest lower extremity sarcoma have a worse outcome than upper extremity sarcoma. The aims of the current study were to evaluate overall survival (OS) and disease-free survival (DFS) of soft tissue sarcomas located in the extremity, and test the prognostic value of a series of clinicopathological parameters. Methods: A Retrospective review was undertaken to identify patients with sarcoma located in the extremities. All patients received their primary surgical treatment in our department between January 1991 and December 2001. Univariate and multivariate analyses of potential predictive factors were evaluated with the log-rank test and Cox regression. Results: Of the 134 patients identified, 99 patients had lower extremity sarcoma and 35 patients had upper extremity sarcoma. No differences in size, stage or adjuvant therapy were identified between upper and lower extremity sarcomas (p=.11, p=.22 and p=.24, respectively). Mean age was 50 years. Median follow-up was 27 months (range 1–116 months). By univariate analysis, stage, size, and adjuvant therapy of the primary tumor were associated with a decreased in both OS (p<.05) and DFS (p<.05). Age 50 years or greater influenced OS (p<.001) but not DFS (p=.21). Histology of the primary tumor did not effect OS (p=.21) but tended to effect DFS (p<.001). Anatomic location and gender did not significantly influence OS or DFS. By multivariate Cox regression, only adjuvant therapy effected DFS (p=.002). Age, gender, histology, size, stage, and adjuvant therapy did not significantly influence DFS. Overall-survival was influenced by age, histology, stage, and adjuvant therapy. Anatomic location did not have an effect on OS (p=.17) or DFS (p=.99). Conclusion: Location of the primary site of extremity sarcoma does not influence overall survival and disease-free survival. Patients with upper extremity sarcoma do not have a worse outcome than patients with lower extremity sarcoma. No significant financial relationships to disclose.

Expression of HER2/neu Does not Correlate with Survival in Soft Tissue Sarcoma

Background: The expression of HER2/neu has been identified as a prognostic factor in several malignant diseases. However, only sparse data exist correlating HER2/neu expression in soft tissue sarcoma with subsequent tumor progression or recurrence. The purpose of this study was to investigate the clinical significance of HER2/neu in adult soft tissue sarcoma (STS). Methods: Tumor specimens of patients with STS were evaluated regarding HER2/neu expression using immunohistochemistry. The significance of the proposed prognostic indicators was evaluated in relation to survival and local recurrence. Results: Of 62 analyzed specimens, 43 tumors were HER2/neu negative compared to 19 HER2/neu positive tumors. Kaplan-Meier analysis indicated no difference in survival according to HER2/neu expression (p = 0.31, log-rank test = 1.10). Variables that were predictive of longer survival included better resection quality (R0, p < 0.01) and smaller tumor size (T1, p = 0.02). Conclusion: HER2/neu expression does not correlate with prognosis of soft tissue sarcomas. Its evaluation for tumor prognosis as well as for the identification for adjuvant therapeutic strategies does not appear warranted at this point.

Radiographic response to neoadjuvant chemotherapy is a predictor of local control and survival in soft tissue sarcomas.

Downstaging of large soft tissue sarcomas can be accomplished by the use of neoadjuvant chemotherapy (NeoCT). The authors tested the hypothesis that radiographic response to NeoCT predicts improved local control and survival. The authors reviewed the medical records of 65 patients with Stage II or III soft tissue sarcoma (42 extremity, 23 retroperitoneal) who were treated with doxorubicin or ifosfamide-based NeoCT from January 1991 to December 1996. Radiographic response and impact on surgical therapy were determined retrospectively by comparing imaging studies obtained before and after chemotherapy. The radiographic responses observed were partial response (PR; 22 patients [34%]); minor response (MR; 6 patients [9%]); stable disease (20 patients [31%]); and progressive disease (17 patients [26%]). Downstaging sufficient to decrease the scope of the operation occurred in 13% of the patients, 78% had no change, and 9% had disease progression sufficient to increase the scope of the operation. Patients having any radiographic response (PR or MR) had a higher margin-negative resection rate, a better local recurrence-free survival rate, and a better overall survival rate than did nonresponders. The NeoCT regimens used in this study resulted in tumor shrinkage sufficient to impact surgical therapy in a few patients. However, radiographic response predicted improved local control and overall survival rate.