Surgical Treatment for Skeletal Metastases From Soft Tissue Sarcomas: Experience With 23 Lesions in 20 Patients

Hideki Yoshikawa,Kazuo Yonenobu,Takahiro Ochi,Atsumasa Uchida,Takafumi Ueda,Nobuhito Araki,Ikuo Kudawara

doi:10.1080/13577149878064

Hideki Yoshikawa, Kazuo Yonenobu + Show 5 more

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https://doi.org/10.1080/13577149878064

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Abstract

Purpose. This paper reports the procedures and the clinical results of a series of surgical treatments for skeletal metastases from soft tissue sarcomas. Subjects and methods. Surgical treatment of metastatic bony lesions from soft tissue sarcomas has been carried out over a 20 year period (1975–1996). Thirty-two patients developed skeletal metastases from soft tissue sarcomas, and 20 of these cases received surgical treatment. The 23 metastatic bony lesions in these 20 patients were treated using the following surgical approaches: wide resection with prosthetic replacement in five lesions, wide or marginal resection without reconstruction in four lesions, intramedullarly nailing with curettage and methylmethacrylate cementation in four lesions, marginal resection of vertebral body with replacement by a ceramic prosthesis in three lesions, laminectomy in three lesions, intramedullarly nailing in two lesions, and curettage in two lesions. Results. Relief of pain was achieved in 17 of the 20 patients. The ambulatory status of the patients with metastasis in the lower extremity or periacetabular region was significantly improved in nine of 10 cases. Seventeen patients died of disease, with a mean survival period of 17.9 months after surgery for metastasis. Discussion. Although surgical treatment for skeletal metastases from soft tissue sarcomas cannot save the life of the patient, it can be of value in improving their well-being and overall quality of life. In these cases, surgical intervention may be more frequently indicated than in tumors with an osteoblastic or mixed pattern.

Highlights

Lung metastasis appears to be most common in patients with distant tumor recurrence, is life threatening, and from recent reports describing increased survival, may be best countered through aggressive metastasectomy.[3,4]
Since a local recurrence has not been detectable during the follow-up period, stabilization via endoprosthetic replacement appears to work well for the treatment of lesions metastasizing to the proximal femur and humerus from soft tissue sarcomas
Of particular note in our study is that in three of the four alveolar soft tissue sarcomas, the mean survival period following surgery was more than 3 years, indicating that surgical intervention seems well indicated for this particular tumor, and longer survival might be expected in other cases, for example, skeletal m etastases from thyroid cancer.[16]

Summary

Introduction

Soft tissue sarcom as have a potential for distant metastasis, and a signi® cant proportion of cases are resistant to recent multimodal treatments involving chemotherapy, radiotherapy and wide local resection.[1,2] Lung metastasis appears to be most common in patients with distant tumor recurrence, is life threatening, and from recent reports describing increased survival, may be best countered through aggressive metastasectomy.[3,4]In contrast, skeletal metastasis occurs with a much lower incidence when compared with the lung,[5,6] but may cause some orthopedic problems.

Results

Conclusion