Radiologic and Pathologic Response Evaluation After Neoadjuvant Chemotherapy for Primary Retroperitoneal Sarcoma: A Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) Collaboration

Stijn J C van der Burg¹, Marco Fiore², Piotr Rutkowski³, Markus Albertsmeier⁴, Sylvie Bonvalot⁵, Valerie P Grignol⁶, Chandrajit P Raut⁷, Ferdinando C M Cananzi^{8

9}, John E Mullinax¹⁰, David E Gyorki¹¹, Elisabetta Pennacchioli¹², Samuel J Ford¹³, Carolyn Nessim¹⁴, Kenneth Cardona¹⁵, Dario Callegaro², Jacek Skoczylas³, Lars H Lindner¹⁶, Alessandro Gronchi², Winan J Van Houdt¹⁷; TransAtlantic Australasian Retroperitoneal Sarcoma Working Group

Affiliations

¹ Department of Surgery, Antoni van Leeuwenhoek Hospital (NKI-AVL), Netherlands Cancer Institute, Amsterdam, The Netherlands.
² Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁴ Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität, University Hospital, Munich, Germany.
⁵ Department of Surgery, Institut Curie, PSL University, Paris, France.
⁶ Department of Surgery, The Ohio State UniversityWexner Medical Center, Columbus, OH, USA.
⁷ Department of Surgery, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
⁹ Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹⁰ Department of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
¹¹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
¹² Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
¹³ Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
¹⁴ Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁵ Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
¹⁶ Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany.
¹⁷ Department of Surgery, Antoni van Leeuwenhoek Hospital (NKI-AVL), Netherlands Cancer Institute, Amsterdam, The Netherlands. w.v.houdt@nki.nl.

PMID: 40374864
DOI: 10.1245/s10434-025-17306-9

Multicenter Study

Radiologic and Pathologic Response Evaluation After Neoadjuvant Chemotherapy for Primary Retroperitoneal Sarcoma: A Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) Collaboration

Stijn J C van der Burg et al. Ann Surg Oncol. 2025 Jul.

. 2025 Jul;32(7):5359-5366.

doi: 10.1245/s10434-025-17306-9. Epub 2025 May 15.

Authors

Affiliations

¹ Department of Surgery, Antoni van Leeuwenhoek Hospital (NKI-AVL), Netherlands Cancer Institute, Amsterdam, The Netherlands.
² Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³ Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
⁴ Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians-Universität, University Hospital, Munich, Germany.
⁵ Department of Surgery, Institut Curie, PSL University, Paris, France.
⁶ Department of Surgery, The Ohio State UniversityWexner Medical Center, Columbus, OH, USA.
⁷ Department of Surgery, Harvard Medical School, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
⁸ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
⁹ Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
¹⁰ Department of Sarcoma, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
¹¹ Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
¹² Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
¹³ Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK.
¹⁴ Department of Surgery, The Ottawa Hospital and Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁵ Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
¹⁶ Department of Medicine III, University Hospital, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany.
¹⁷ Department of Surgery, Antoni van Leeuwenhoek Hospital (NKI-AVL), Netherlands Cancer Institute, Amsterdam, The Netherlands. w.v.houdt@nki.nl.

PMID: 40374864
DOI: 10.1245/s10434-025-17306-9

Abstract

Background: Comsplete resection is the primary treatment for retroperitoneal sarcomas (RPS). The role of neoadjuvant chemotherapy (NACT) in improving oncologic outcomes is currently under investigation in the STRASS 2 trial. This study assessed the association between change in tumor size or pathologic response and oncologic outcomes.

Methods: Data were retrieved from the international Retroperitoneal Sarcoma Registry and included patients who had RPS treated with NACT between January 2017 and October 2020. The correlation between radiologic response (RECIST1.1), change in tumor size, pathologic response, and oncologic outcomes was evaluated. Binary logistic, Cox, and polynomial spline regression and log-rank tests were performed as statistical analyses.

Results: The study enrolled 141 patients from 14 medical centers. The most common histologies were dedifferentiated liposarcoma (36.9 %) and leiomyosarcoma (34 %). At completion of NACT, 14.5 % of the patients, had a partial response (PR), 63.3 % had stable disease (SD), and 22.2 % had progressive disease (PD). The hazard ratio of PD after NACT for overall survival (OS) was 1.9 (95 % confidence interval [CI], 0.9-4.1). A linear trend was observed between tumor growth and death rate. At early radiologic evaluation during NACT, PD was significantly associated, with worse OS (HR, 5.4; 95 % CI, 1.1-25.3). Partial response was significantly correlated with ≥20 % fibrosis/hyalinization (odds ratio [OR], 5.6; 95 % CI, 1.1-29.0).

Conclusion: Progression in RPS on an early evaluation scan is associated with worse OS, and radiologic response is correlated with pathologic response based on fibrosis/hyalinization. A larger cohort is necessary for more significant associations between radiologic or pathologic response and oncologic outcomes.

Keywords: Oncologic outcomes; Progressive disease; Radiologic response; Retroperitoneal sarcoma; Tumor size.

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Conflict of interest statement

Disclosure: Ferdinando Cananzi received a speaking fee from Istituto Gentili in 2022. John Mullinax is the inventor of the Moffitt Cancer Center’s licensed intellectual property (IP) related to the proliferation and expansion of tumor-infiltrating lymphocytes (TILs) to Iovance Biotherapeutics. Dr. Mullinax has participated in sponsored research agreements with Iovance Biotherapeutics, Intellia Therapeutics, and SQZ Biotech, has received research support from NIH-NCI (K08CA252642), Ocala Royal Dames, and V Foundation, and has received ad hoc consulting fees from Merit Medical, Lyell Immunopharma, and Iovance Biotherapeutics. The remaining authors have no conflicts of interest.

References

1. van Houdt WJ, Zaidi S, Messiou C, Thway K, Strauss DC, Jones RL. Treatment of retroperitoneal sarcoma: current standards and new developments. Curr Opin Oncol. 2017;29:260–7. - DOI - PubMed
1. Turgeon MK, Cardona K. Retroperitoneal sarcomas: histology is everything. Surg Clin North Am. 2022;102:601–14. - DOI - PubMed
1. Patkar S, Kattepur AK, Khanna N, Bajpai J. Retroperitoneal sarcomas: a current review on management. Indian J Surg Oncol. 2022;13:542–58. - DOI - PubMed - PMC
1. Gronchi A, Strauss DC, Miceli R, Bonvalot S, Swallow CJ, Hohenberger P, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multi-institutional Collaborative RPS Working Group. Ann Surg. 2016;263:1002–9. - DOI - PubMed
1. Tan MC, Brennan MF, Kuk D, Agaram NP, Antonescu CR, Qin LX, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2016;263:593–600. - DOI - PubMed

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Radiologic and Pathologic Response Evaluation After Neoadjuvant Chemotherapy for Primary Retroperitoneal Sarcoma: A Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) Collaboration

Affiliations

Radiologic and Pathologic Response Evaluation After Neoadjuvant Chemotherapy for Primary Retroperitoneal Sarcoma: A Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) Collaboration

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials