Treatment, Management and Outcomes of Brain Metastasis in Adult Sarcoma

Abstract

<h3>Purpose/Objective(s)</h3> Metastases from adult sarcomas often develop in the lungs, bone, and liver, yet brain metastases are less common. Few studies have discussed the incidence and prognosis of sarcoma brain metastases, and limited data exists regarding the differences in treatment patterns and outcomes by treatment modality. <h3>Materials/Methods</h3> We performed a retrospective analysis of sarcoma patients with a diagnosis of brain metastasis treated at our institution between 2009-2020. Baseline patient and tumor characteristics were analyzed. Patients were stratified based on treatment modality (surgery, radiosurgery, external beam radiotherapy (RT), and surgery plus RT). Outcome measures were rates of local failure (LF) and toxicities with different modalities. Univariate analysis was performed to study associations between clinical factors and our primary endpoints. <h3>Results</h3> A total of 22 patients with 103 brain metastases were included. Most common histologies were leiomyosarcoma (5 patients, 22%), pleomorphic sarcoma (4 patients, 18%), chondrosarcoma and round cell sarcoma (2 patients each, 9%). Of the 103 lesions included, 4 (18%) were solitary lesions with a median size of 1.7cc (range 0.3 – 12.0 cm). All patients received treatment, 4 underwent surgery alone (18%), 5 received RT alone, and 13 underwent surgery plus RT. Radiotherapy techniques included radiosurgery or external beam RT. 63 lesions (61%) were treated with stereotactic radiosurgery with a median dose of 24 Gy (range 15-60 Gy). The median OS was 62 months (95% CI 18-74). At 1 year, the cumulative incidence of local failure was 8.1% (95% CI 3.5% - 15.2%). Rates of LF differed by treatment modality – 5 failures occurred with surgery alone (20%), 2 with RT alone (3.4%), and 1 with surgery plus RT (1.1%). Grade I-IV toxicities were higher with surgery plus RT (n=13, 59%) compared to surgery (n=4, 18.1%) or RT alone (n=5, 18.1%). <h3>Conclusion</h3> Our study describes tumor presentation, management, and outcomes for metastatic intracranial sarcoma. We show that surgery and radiotherapy are effective modalities to utilize in management of these patients with low rates of local failure. Use of multimodal therapy (surgery plus RT) may further improve tumor control rates, though may be associated with higher rates of toxicities.