Primary lung sarcomas. The Mayo Clinic experience

Abstract

7370 Background: Primary lung sarcomas are rare tumors accounting for 0.013% to 0.4% of all lung malignancies. It is estimated that 1 in 500 primary lung malignancies is a sarcoma. At our institution, primary lung sarcomas represent 0.6% of lung cancers. With less than 250 patients reported in the English medical literature, very little is known about the clinical behavior and treatment of these tumors. The primary goal of this study was to review the Mayo Clinic experience with this rate tumors. Methods: All cases of primary lung sarcomas seen at the Mayo Clinic from 1976 to 2002 were reviewed. Medical records were analyzed for demographic information as well as for survival and treatment data. Pathology specimens were reviewed to confirm the diagnosis of primary lung sarcoma. Results: A total of 65 cases of primary lung sarcoma were found during the last 52 years at Mayo Clinic. Most patients presented with persistent respiratory symptoms such as chest pain, cough, hemoptysis and dyspnea. Hypoglycemia, which has been described in patients with this malignancy, was seen only in one patient with a very large tumor. The main duration of symptoms at the time of diagnosis was 2 months. The presence of an infiltrate or a mass was the most common finding (90%). In most cases, the tumor was more than 5 cm in diameter (65%). Surgery was the main treatment modality (lobectomy 70%, wedge resection 20%, and pneumonectomy 10%). Radiation as the only treatment modality was used in 18% of patients. Adjuvant chemotherapy or radiation was used in 30% of cases. Relapses were treated with surgery followed by chemotherapy and radiation or both. Survival was estimated to be 30 months. Conclusions: Diagnosis of primary lung sarcoma requires careful exclusion of primary sarcoma elsewhere. Surgical resection, if complete, is curative for small, well-differentiated primary lung sarcomas. Poorly differentiated tumors are less curable, but resection may provide palliation and should be considered. Unresectable or recurrent sarcomas may be treated with radiation therapy or chemotherapy, although responses are usually brief and survival is less than 1 year. No significant financial relationships to disclose.