Elsevier

European Journal of Cancer

Volume 41, Issue 18, December 2005, Pages 2853-2860
European Journal of Cancer

Differential sensitivity of liposarcoma subtypes to chemotherapy

https://doi.org/10.1016/j.ejca.2005.07.023Get rights and content

Abstract

Liposarcoma is one of the most common soft tissue sarcomas and has a number of different subtypes: well-differentiated; dedifferentiated; myxoid/round cell; and pleomorphic. However, the response of these subgroups to chemotherapy is not well documented. In this study, we have conducted a retrospective analysis of a prospectively maintained database of soft tissue sarcoma patients treated at the Royal Marsden Hospital. Eighty-eight liposarcoma patients who received chemotherapy between August 1989 and June 2004 were identified. The response rates to chemotherapy of the different histological subtypes and overall and progression free survival were investigated. Survival according to histological grade was also assessed. A statistically significant higher response rate to first-line chemotherapy was observed in patients with myxoid liposarcoma compared to de- and well-differentiated tumours, 48% (95%CI; 28–69) and 11% (95%CI; 2–29), P = 0.005. Similarly, those with myxoid liposarcoma had a significantly higher response rate compared to all other liposarcoma patients, 48% (95%CI; 28–69) and 18% (95%CI; 8–31). Patients with lower grade tumours had better overall survival. This retrospective analysis suggests that myxoid liposarcoma is relatively chemosensitive in comparison to a combination of other liposarcomas, and in particular de- and well-differentiated tumours. Further confirmation of these results should be sought by similar analyses of other databases.

Introduction

Soft tissue sarcomas are a group of mesodermal malignancies that encompass a wide spectrum of different histological entities. One of the most common is liposarcoma, which has a peak incidence between 50 and 65 years of age [1]. Several subtypes exist: well-differentiated, dedifferentiated, myxoid/round cell and pleomorphic. Myxoid and well-differentiated liposarcoma are generally regarded as low-grade malignancies [2]. Myxoid is the most common subtype, accounting for 40–50% of all liposarcomas [1], and tends to metastasise to soft tissue locations such as the retroperitoneum, axilla and chest wall 2, 3, 4. Round cell liposarcoma is considered a poorly differentiated form of myxoid liposarcoma, as round cell and myxoid regions are not infrequently found within the same tumour [5]. Supporting this hypothesis are cytogenetic data demonstrating a consistent, balanced chromosomal translocation, t(12;16)(q13;p11) in both round cell and myxoid variants 2, 5, 6. Despite complete gross excision, late local recurrences are common for well-differentiated and dedifferentiated liposarcomas 7, 8. However, the development of dedifferentiation is an ominous feature associated with a greater potential to metastasise [7]. Pleomorphic liposarcoma is the least common variant, accounting for approximately 5% of all liposarcomas 9, 10.

Anecdotally, these tumours are chemo- and radio-resistant, although there have been reports of responses in myxoid liposarcoma patients treated with chemotherapy 11, 3. The initial treatment modality of choice remains surgical resection. The aim of this study was to ascertain the efficacy of chemotherapy as first-line treatment for metastatic and inoperable disease, with specific attention to the different histological subgroups of liposarcoma.

Section snippets

Patients

Full local ethics and research committee approval was obtained prior to commencing the study. A retrospective analysis of a prospectively maintained database of all soft tissue sarcoma patients treated at our institution was performed. Patients with a histological diagnosis of liposarcoma who had also received chemotherapy were identified. Eighty-eight liposarcoma patients received chemotherapy between September 1979 and June 2004. One patient received adjuvant chemotherapy at another

Patient characteristics

Between August 1989 and June 2004, 88 patients were treated with chemotherapy for liposarcoma. At the time of analysis, 12 (14%) patients remained alive and 68 (77%) had died (apart from one) secondary to liposarcoma. Follow-up information was not available on 8 (9%) people as they returned to their country of origin following their last visit at the Royal Marsden Hospital. The median follow-up was 89 months from diagnosis and 18 months from first-line chemotherapy.

The patient characteristics

Discussion

This retrospective study demonstrates that in liposarcoma patients receiving first-line chemotherapy for palliation of advanced disease, there was a statistically significant higher response rate for patients with myxoid liposarcoma compared to a combination of all other liposarcomas, and in particular to de- and well-differentiated liposarcoma.

Liposarcoma was identified as a favourable prognostic factor for response to chemotherapy in an analysis of 2185 soft tissue sarcoma patients treated

Conflict of interest statement

The authors declare no conflict of interest.

Acknowledgement

We thank Dr. Roger A’hern for his assistance with the statistical analysis.

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