Soft Tissue Sarcomas: The Role of Quantitative MRI in Treatment Response Evaluation

Background: Although curative surgery remains the cornerstone of the therapeutic strategy in patients with soft tissue sarcomas (STS), neoadjuvant radiotherapy and chemotherapy (NART and NACT, respectively) are increasingly used to improve operability, surgical mar-gins and patient outcome. The best imaging modality for locoregional assessment of STS is MRI but these tumors are mostly evaluated in a qualitative manner. Objective: After an overview of the current standard of care regarding treatment for patients with locally advanced STS, this review aims to summarize the principles and limitations of (i) the current methods used to evaluate response to neoadjuvant treatment in clinical prac-tice and clinical trials in STS (RECIST 1.1 and modified Choi criteria), (ii) quantitative MRI sequences (i.e., diffusion weighted imaging and dynamic contrast enhanced MRI), and (iii) texture analyses and (delta-) radiomics.

Automated summary

This article provides an overview of the current standard of care for patients with locally advanced STS, and summarizes the methods and limitations for evaluating response to neoadjuvant treatment, including the methods used in clinical practice and clinical trials, quantitative MRI sequences, and texture analysis.