• Amandine Crombé, François Le Loarer, Eberhard Stoeckle, Sophie Cousin, Audrey Michot, Antoine Italiano, Xavier Buy, and Michèle Kind.
• Department of Radiology, Institut Bergonie, F-33000, Bordeaux, France; INRIA Bordeaux-Sud-Ouest, CNRS UMR 5251, F-33405, Talence, France; Université de Bordeaux, F-33000, Bordeaux, France. Electronic address: a.crombe@bordeaux.unicancer.fr.
• Eur J Radiol. 2018 Dec 1; 109: 178-187.

ObjectivesTo determine if changes in surrounding tissues of soft-tissue sarcomas (STS) evaluated by MRI during neoadjuvant chemotherapy (NAC) are associated with the histological response and satellite tumorous cells beyond the pseudocapsule on surgical specimen, disease-free survival (DFS) and overall survival (OS).MethodsFifty-seven adult patients with locally advanced high-grade STS of extremities and trunk wall were included in this single-centre retrospective study. All were uniformly treated by 5-6 cycles of anthracycline-based NAC, curative surgery and adjuvant radiotherapy and had available MRI with a gadolinium-chelates administration at baseline and after 2 cycles. Thirty-seven patients also had a pre-operative MRI. Two senior radiologists evaluated MRI growth pattern, oedema, contrast-enhanced oedema, aponeurotic enhancement, and their qualitative changes during NAC. An expert pathologist reviewed all surgical specimens. A good histological response was defined as <10% viable cells. Associations with pathological findings were estimated with Fisher and Chi-square tests and multivariate analysis with binary logistic regression. Survival analyses included log-rank tests.ResultsForty-two patients had poor responses and 25 had satellite tumorous cells on surgical specimen. Changes in surrounding oedema and in contrast-enhanced oedema were associated with responses (p = 0.008 and 0.011, respectively). Diffuse infiltrative growth pattern (IGP) on baseline MRI, changes in margin definition and in contrast-enhanced oedema at early evaluation were associated with satellite tumorous cells (p = 0.039, 0.011 and 0.009, respectively). Diffuse IGP on baseline MRI and stable or increased oedema during treatment were predictors of DFS (p = 0.009 and 0.040, respectively).ConclusionSurrounding tissues of STS during NAC should be carefully evaluated as they may steer treatment efficacy and patient prognosis.Copyright © 2018 Elsevier B.V. All rights reserved.

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