The Treatment and Outcome of Patients With Soft Tissue Sarcomas and Synchronous Metastases

Abstract

Most primary tumors were >/=10 cm (58%), high-grade histology (77%), and located on the extremity (60%).The most frequent site of metastatic disease was the lung (63%); 27% of patients had metastases to >/=2 organ sites. Surgery to the primary tumor was performed in 94% of patients (n = 45) and 68% had additional radiation therapy (n = 32). Thirty- five percent of patients underwent at least one metastastectomy (n = 17). Chemotherapy was administered to 90% of patients (n = 43); 31% received >/=3 different regimens (n = 15) and 25% were given intra-arterial or intracavitary therapy (n = 12). Median overall survival was 15 months with a 21% 2-year survival. Local control of the primary tumor was achieved in 54% (n = 26), and metastastectomy was performed in 35% (n = 17). No analyzed factors were associated with an improvement in overall survivalConclusions: Despite multiple poor prognostic factors, the survival of patients with STS and metastases is comparable to those who develop delayed metastatic disease. However, unlike patients who present with metachronous disease, there was no improved survival observed for patients treated with metastastectomy. Consequently, treatment for patients with STS and synchronous metastases should be approached with caution. Surgical management of STS with synchronous metastases must be considered palliative and should be reserved for patients requiring palliation of symptoms. Patients must also be well informed of the noncurative nature of the procedure.

Retrospective analysis of metastatic sarcoma patients

“…Of all patients diagnosed with malignant musculoskeletal tumors, 5-30% (1-3) have a recurrence and 10-38% of patients present with clinically detectable metastases (4)(5)(6). A number of studies have reported the survival of patients who have undergone either a lung metastasectomy or chemotherapy (4,5,(7)(8)(9).However, little is known about the clinical course of patients with bone or soft tissue sarcomas who have succumbed to the disease. For example, only a few reports are available regarding the clinical course, such as the metastatic site, which led to the cause of death or the survival time following initial detection of metastases (10).…”

The clinical outcome of pazopanib treatment in Japanese patients with relapsed soft tissue sarcoma: A Japanese Musculoskeletal Oncology Group (JMOG) study

“…From 5% to 30% of patients with STS have a local recurrence, and from 10% to 38% present with clinically detectable metastases 2, 3, 4, 5. The development of new systemic treatments for patients with STS has been limited in the past few decades.…”

Local and systemic antitumor effect of intratumoral and peritumoral IL-12 electrogene therapy on murine sarcoma

“…Other treatment options include radiotherapy and chemotherapy, which can be combined with surgical techniques for larger lesions, since large tumors (>5 cm in diameter) respond poorly to nonsurgical treatment. 1,2 In humans with metastatic disease, chemotherapy produces poor response rates of 20%, which does not have an impact on overall survival. 1,2 Overall, five year survival rate is approximately 35-65%, with size of the tumor being the most important prognostic factor.…”

“…1,2 In humans with metastatic disease, chemotherapy produces poor response rates of 20%, which does not have an impact on overall survival. 1,2 Overall, five year survival rate is approximately 35-65%, with size of the tumor being the most important prognostic factor. 1,3 Due to a poor response rate and limited treatment options, newer therapeutic approaches are considered, either as primary or adjuvant therapy to conventional methods in order to improve the clinical outcome of cancer treatment.…”