Brain metastases from Truncal and extremity bone and soft tissue sarcoma: Single institution study of oncologic outcomes

Abstract

Brain metastases are a rare occurrence in patients with sarcoma. The prognosis for patients is poor, and treatment can contribute to considerable morbidity. We sought to examine the experience of our institution in managing these patients over a period of 17 years. We performed a retrospective cohort study of patients managed for sarcoma of the extremity or trunk who developed brain metastases from 2000 to 2017. Clinical data were analyzed and we assessed survival outcomes. 14 patients presenting at a mean age of 46.7 years were included. All patients were treated with radiotherapy for their brain metastases. 3 patients underwent surgical excision of their intracranial metastases. Two patients were treated with radium-223 dichloride. Kaplan–Meier survival analysis and the log rank test were used to calculate the survival probability, and to compare patient subgroups. All patients in this study developed lung or bone metastases at a mean interval of 13.3 months prior to the development of brain metastasis. The median interval from diagnosis of a brain metastasis to death was 3.6 months. The Kaplan–Meier survival probability at 6 months was 28.6%, and 14.3% at 1 year. Surgery was not found to be associated with increased survival. Patients with cerebellar metastasis had increased survival probability as compared to those with cerebral metastasis. Patients with extremity or trunk sarcoma who develop brain metastases frequently develop lung or bone metastases in the year preceding their diagnosis of brain metastasis. Patients with cerebellar metastasis may have better survival than those with cerebral metastasis, and an aggressive treatment approach should be considered. Despite aggressive treatment, the prognosis is grim.

Brain Metastases in Patients With Soft-Tissue Sarcomas: Management and Survival—A SEER Population-Based Cohort Study

“…In accordance with our findings, studies show that most patients with BM had a lower limb primary tumor, 5 , 10 with most being localized to the thigh. 10 In addition, we encountered that patients with BM tended to have larger primary tumors with 27.3% being >15 cm in their greatest dimension (T4 stage).…”

“…The mean age of patients with BM in this study was 49.5 years. This value falls between the mean age reported by Salvati et al 7 (33.1 years) and Chan et al 5 (56.6 years). Both of these studies also demonstrated a male predominance unlike ours (59.1% of patients with BM were women).…”

“… 1 Nonetheless, other imaging strategies may be useful for STS that metastasize to different organs. Chan et al 5 listed not screening for brain metastases (BM) as a limitation to their retrospective cohort study. Because all patients had neurological symptoms at the time of BM diagnosis, it was presumed that there was a lag in the detection of asymptomatic patients.…”

“…Traditionally, surgical resection with or without adjuvant RT represented the basis for treatment in patients with BM. 10 Although this may be true for certain subtypes of STS, 5 , 7 , 11 the development of combination therapies with monoclonal antibodies may be a game changer for specific patient populations. 12 …”

Novel Insights into the Immunotherapy of Soft Tissue Sarcomas: Do We Need a Change of Perspective?

“…However, retroperitoneal STSs also tend to metastasize to the liver [14,15]. Other metastatic sites commonly include the bones and the brain [16,17]. Patients with STSs are managed according to the generally accepted guidelines and those with localized and resectable diseases are treated by surgery [18].…”