• Takafumi Ueda, Norifumi Naka, Nobuhito Araki, Takeshi Ishii, Hiroyuki Tsuchiya, Hideki Yoshikawa, Kazuo Mochizuki, Tadao Tsuboyama, Junya Toguchida, Toshifumi Ozaki, Hiroaki Murata, Ikuo Kudawara, Kazuhiro Tanaka, Yukihide Iwamoto, Yasuo Yazawa, Kazuyoshi Kushida, Takanobu Otsuka, and Keiji Sato.
• Department of Orthopaedic Surgery, Osaka National Hospital, Kinki-Block Comprehensive Cancer Center, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006, Japan.
• J Orthop Sci. 2008 Jul 1; 13 (4): 304-12.

BackgroundThe radiographic evaluation of the response to preoperative chemotherapy for bone and soft tissue sarcomas is based mostly on the change in primary tumor size before and after chemotherapy, as is done for many solid cancers. Its prognostic correlation, however, has hardly been validated.MethodsWe conducted a retrospective validation study of the Japanese Orthopaedic Association (JOA) radiographic response evaluation criteria of preoperative chemotherapy for bone and soft tissue sarcomas as a JOA Committee on Musculoskeletal Tumors cooperative study. A total of 125 consecutive patients with high-grade bone (n = 77) and soft tissue (n = 48) sarcomas treated with neoadjuvant chemotherapy and definitive surgery in 25 tertiary referral hospitals were selected for the study. We investigated the correlation between the tumor size-based radiographic response evaluation criteria of preoperative chemotherapy for bone and soft tissue sarcomas provided by the JOA Committee on Musculoskeletal Tumors (hereafter called the JOA criteria) and the patients' overall survival using the Kaplan-Meier method and the log-rank test.ResultsThe JOA criteria correlated relatively well with survival for malignant bone tumors (mostly comprising osteosarcoma and Ewing's sarcoma) but not for soft tissue sarcomas, suggesting that the tumor size-based radiographic evaluation criteria for the response to preoperative chemotherapy in patients with soft tissue sarcomas is invalid.ConclusionsThe JOA criteria, based on the change in primary tumor size, is valid for malignant bone tumors but invalid for soft tissue sarcomas. Other new evaluation modalities of the response to preoperative chemotherapy using innovative functional imaging techniques are needed for soft tissue sarcomas.

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