Multimodality therapy for pulmonary metastasis in sarcoma patients: Results of a single institution.

Abstract

10070 Background: Pulmonary metastasectomy (PM) for sarcoma can result in significant long term survival in carefully selected patients (pts). We report our experience with pulmonary metastasectomy. Methods: After IRB approval, 120 pts who underwent PM for sarcoma at Moffitt Cancer Center from 1999 to 2011 were reviewed. Survival was calculated according to the Kaplan-Meier method with Cox proportional hazard univariate (UV) and multivariate (MV) models used to analyze relationships between clinicopathologic variables and overall survival (OS). P-value < 0.05 was considered significant. Results: Median age was 51 yrs, 95(79%) pts had soft tissue sarcomas with pleomorphic being most common. Of the 25(21%) osseous sarcomas, osteosarcoma was most common. 20(15%) had synchronous metastasis (mets); of the pts with local disease only, median time to recurrence from primary resection was 13 months (mo). OS from initial resection was 55 mo for pts with local disease only vs. 27 mo for pts with synchronous mets. On UV analysis, use of radiation, number of index lesions, presence of synchronous mets and time to recurrence achieved significance. On MV analysis, only shorter time to recurrence (p=.03) and presence of synchronous mets (p=.04) were independent predictors of poor survival. 63(52%) pts [26(22%) neoadjuvant, 19(16%) adjuvant, 18(15%) both] received chemotherapy for the primary tumor, while 57(48%) did not. There was a trend towards poor survival in pts receiving chemotherapy compared to pts receiving no chemotherapy (p=0.06, HR 1.59). In addition 40(34%) pts received chemotherapy prior to PM with no difference in OS compared to pts who did not get chemotherapy (p=0.1, HR 1.55). 71(59%) had 1 PM, 32(27%) had 2 and 17(14%) had 3 or more PM with OS being 17 mo, 37 mo and 34 mo in each group, respectively. A higher number of PM was associated with improved survival (p=.01). Conclusions: Pts with a shorter disease free interval have a decreased OS as do pts with synchronous mets. Pts undergoing multiple PM have a survival benefit likely resulting from favorable disease biology. Failure of chemotherapy to show a survival benefit may be a result of selection bias for patients with aggressive disease being treated with chemotherapy.