Pulmonary Metastasectomy For Soft Tissue Sarcoma Research Articles

Is Repeat Pulmonary Metastasectomy Indicated for Soft Tissue Sarcoma?

Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival. We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM. After initial PM, 63% of patients (n= 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger (p= 0.033) underwent minimally invasive resection at first PM (p= 0.041), had a longer disease-free interval after first PM (p= 0.009), were without extrapulmonary disease (p < 0.001), and had fewer nodules on recurrence (p < 0.001) were more likely to undergo repeat PM. Comparison between the repeat and non-repeat PM groups demonstrated an increased hazard of death among patients managed nonoperatively. Factors associated with an increased hazard of death after second PM included preoperative chemotherapy (p= 0.008) and R1/R2 metastasectomy (p < 0.001). Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival.

The surgeon will see you now: selecting soft-tissue sarcoma patients for pulmonary metastasectomy

Soft-tissue sarcoma (STS) is a heterogeneous disease comprised by a number of histologic subtypes. Patterns of metastases, however, are common amongst these tumors. In particular, the lung is the primary site of metastases in STS and pulmonary metastases develop in up to 50% of STS patients (1-4). In the relative absence of effective systemic therapy, metastatic STS presents significant challenges in oncology, and pulmonary metastasectomy (PM) has become a common therapeutic modality for patients with metastatic pulmonary disease (3,5). The data underlying the rationale for PM for STS, however, are comprised predominantly by low level evidence, and it has been argued that the favorable outcomes of PM studies are resultant from selection biases towards tumors with favorable tumor biology. Whereas to some extent this may be true, an opposing argument supports the viewpoint that a thorough understanding of patient characteristics associated with favorable clinical outcomes could be utilized to intentionally select individuals in whom PM is beneficial. Such data would be clinically useful and could contribute to a decision-making framework for patients with STS.

Pulmonary metastasectomy with therapeutic intent for soft-tissue sarcoma

ObjectiveSoft-tissue sarcoma is a heterogeneous disease that frequently includes the development of pulmonary metastases. The purpose of this study is to determine factors associated with improved survival among patients with soft-tissue sarcoma to help guide selection for pulmonary metastasectomy. MethodsWe reviewed a prospectively maintained database and identified 803 patients who underwent pulmonary metastasectomy for metastatic soft-tissue sarcoma between September 1991 and June 2014; of these, 539 patients undergoing 760 therapeutic-intent pulmonary metastasectomies were included. Clinicopathologic variables and characteristics of treatment were examined. The outcomes of interest were overall survival and disease-free survival. Survival was estimated with the Kaplan-Meier method and compared between variables with the log-rank test. Factors associated with hazard of death and recurrence were identified via the use of univariable and multivariable Cox proportional hazards models. ResultsMedian overall survival was 33.2 months (95% confidence interval, 29.9-37.1), and median disease-free survival was 6.8 months (95% confidence interval, 6.0-8.0). In multivariable analyses, leiomyosarcoma histologic subtype (P = .007), primary tumor size ≤10 cm (P = .006), increasing time from primary tumor resection to development of metastases (P < .001), solitary lung metastasis (P = .001), and minimally invasive resection (P = .023) were associated with lower hazard of death. Disease-free interval ≥1 year (P = .002), and 1 pulmonary metastasis (P < .001) were associated with lower hazard of disease recurrence. ConclusionsIn a large single-institution study, primary tumor histologic subtype and size, numbers of pulmonary metastases, disease-free interval, and selection for minimally invasive resection are associated with increased survival in patients undergoing pulmonary metastasectomy for soft-tissue sarcoma.

Pulmonary metastasectomy and repeat metastasectomy for soft-tissue sarcoma

For patients with lung metastases from soft-tissue sarcoma, pulmonary metastasectomy is considered to be the only chance of possible cure. In this survey, we analyzed some potential prognostic factors affecting the outcome in these patients. 34 patients who underwent pulmonary metastasectomy for soft-tissue sarcoma from April 1996 to April 2007, were enrolled in our study. The median follow-up period was 26 months. Survival curves, factors affecting the outcome, and treatment success rate were evaluated. Complete resection was achieved in 88.2% of patients. There was no perioperative mortality. The median overall survival and median disease-free survival were 42 and 27 months, respectively. Incomplete resection and bilateral lung metastases had significant adverse effects on overall survival. Shorter disease-free interval (<18 months) was a significant predictor of survival on multivariate analysis. Metastasectomy was attempted in 12 cases of whom 50% remained disease-free to the end of follow-up. Complete resection is the most important defining factor of success rate and survival. Patients with bilateral lung metastases or a shorter disease-free interval have significantly lower success rates. Repeat metastasectomy is curative in many patients.