A single-institution, multidisciplinary approach to primary localized chest wall sarcomas

Abstract

9054 Background: Primary sarcomas involving the chest wall are rare and data concerning treatment and results are sparse. Methods: We reviewed our experience with these sarcomas by using a multidisciplinary approach. A 12 year retrospective study identified 17 adult patients referred to our centre with localized primary bony or softy tissue sarcomas of the chest wall. Median age was 42 years (17–67). The male/female ratio was 3.5:1.Presenting complaints were swelling, pain or both. Tumor location were the rib (n=7) and clavicle (n=2) for bony tumors and posterior chest wall for softy tissue tumors (n=8). Histological types included: Ewing sarcomas (n=5), osteosarcomas (n=2), chondrosarcomas (n=4), malignant fibrous histiocytomas (n=2), and other types (n=4). Results: Twelve patients underwent up-front “en bloc” resections. Five patients (pts) underwent initial biopsy followed by resection. Surgical resections were microscopically complete (R0) for 9 pts, microscopically incomplete (R1) for 7 and macroscopically incomplete (R2) for one. Associated therapies were: radiotherapy for 10 pts (6/8 pts with incomplete resection, 4/9 with complete resection) and chemotherapy (pre-operatively for 5 pts, post-operatively for 13). Thirteen pts (76.5%) achieved adequate local tumor control. Seven pts (41.2%) developed local recurrence (LR) but 2 developed both RL + metastases and 3 developed metastases only. The incidence rate of LR was 23% (3/13 pts) in the adequate local control group and 100% in the local treatment failure group. Median follow-up was 38 months (6–168) and revealed 8 deaths. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 56% and 44%. Histology type and the pattern of first relapse were the most significant predictors of OS (p= 0.04; p=0.03). Patients (n=7) with a LR alone (43% alive at 60 months) had a significantly better survival than those with metastases (no patient alive at 36 months). Adequate local control was the major predictor of DFS (p= 0.01). Conclusion: Chest wall sarcomas are rare and require a combined aggressive multidisciplinary approach. The achievement of tumor local control is a critical step in their treatment process. No significant financial relationships to disclose.