Tumor Calcification: A New Response Pattern of Myxoid Liposarcoma to Trabectedin
A 63-year-old woman without any underlying disease was diagnosed with a large tumor in the posterior part of the left thigh in January 2011. The first magnetic resonance imaging showed a heterogeneous mass with a diameter of 295 mm (fig. ). The patient was initially managed by a surgeon at a tertiary center. The community center surgeon performed an open biopsy, which resulted in a wound that never healed. The diagnosis was myxoid liposarcoma associated with small round cells (MRCL). The chest and abdominopelvic CT scan revealed the presence of multiple metastases, including a mediastinal mass (38 mm; fig. ).\nBased on the metastatic spread and the nature of the disease, the multidisciplinary committee suggested the inclusion of the patient into a randomized, multicenter phase III study (ET-C-002–07 study; ClinicalTrials.gov identifier: NCT00796120) that evaluated trabectedin 1.5 mg/m2 given as a 24-hour intravenous infusion q3w versus doxorubicin-based chemotherapy as a first-line therapy in patients with translocation-related sarcomas. Once the patient signed the informed consent form, she was randomly assigned to the trabectedin arm. Before chemotherapy, the tumor was painful. That resulted in the administration of opioids and it was associated with severe asthenia. The first cycle of treatment was administered in March 2011. The patient received 14 cycles until January 2012. The treatment was then stopped due to hematological toxicity (grade 3 anemia, grade 3 thrombopenia, and recurrent infections). Throughout the trial, the tumor response was evaluated every 6 weeks. According to the response evaluation criteria in solid tumor (RECIST) guidelines, we observed a stable disease. In parallel, the pain intensity progressively decreased and the asthenia became markedly less, although the site of the open biopsy has not healed and a daily and abundant necrotic material flow continues to be observed. Since January 2012, the patient was examined regularly. During the last visit, we observed the following: excellent general condition, absence of pain, remaining necrotic material including macroscopic calcifications flows (fig. ) and calcification of the primary tumor (fig. , fig. ) and the metastasis (fig. ). Response and symptomatic improvement maintained until November 2013.\nThe patient had formally consented for the publication of the case report to be published.