Differential sensitivity of liposarcoma subtypes to chemotherapy
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.
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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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