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Nguyen A, Nguyen A, Fleeting C, Patel A, Bazett N, Hey G, Mandavali A, Brown NJ, Woolridge M, Foreman M, Lucke-Wold B. An Evaluation of Risk Factors for Intracranial Metastases of Sarcomas: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:e683-e699. [PMID: 38704144 DOI: 10.1016/j.wneu.2024.04.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Sarcomas, a group of neoplasms comprising both tissue and bone soft tissue tumors, has an increasing prevalence in recent years. Prognosis significantly hinges on early detection, and if not detected early, may consequently metastasize. This review will be the first systematic review and meta-analysis characterizing the presentation and progression of brain metastases from bone and soft tissue cancers. METHODS The PubMed, Scopus, and Web of Science databases were queried to identify studies reporting the incidence of intracranial brain metastases from primary sarcoma to the present. Abstract and full-text screening of 1822 initial articles returned by preliminary search yielded 28 studies for inclusion and data extraction. Qualitative assessment of the studies was conducted in accordance with the Newcastle-Ottawa Scale criteria. Meta-analyses were applied to assess risk factors on outcomes. RESULTS The average age within the cohort was 27.9 years with a male and female prevalence of 59.1% and 40.9%, respectively. The odds ratio for living status (dead/alive) was calculated for several risk factors - male/female [OR 1.14, 95% CI 0.62, 2.07], single/multiple metastases [OR 0.67, 95% CI 0.35, 1.28], lung metastases/not [OR 1.63, 95% CI 0.85, 3.13], surgery/no surgery [OR 0.49, 95% CI 0.20, 1.21]. The standardized mean differences for duration from diagnoses to metastases were likewise analyzed - male/female [SMD 0.13, 95% CI -0.15, 0.42], single/multiple metastases [SMD 0.11, 95% CI -0.20, 0.42], lung metastases/not [SMD -0.03, 95% CI -0.38, 0.32], surgery/no surgery [SMD 0.45, 95% CI -0.18, 1.09]. The standardized mean differences for duration from metastases to death were analyzed - lung metastases/not [SMD 0.43, 95% CI -0.08, 0.95]. CONCLUSIONS Our study observed no statistically significant differences in mortality rate among several patient risk factors. Consequentially, there lacks a clear answer as to whether or not an association between mortality rates exists with these patient factors. As such, it is important to continue research in brain-metastasizing sarcomas despite their relative rarity.
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Affiliation(s)
| | - Andrew Nguyen
- College of Medicine, University of Florida, Gainesville, Florida, USA.
| | - Chance Fleeting
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aashay Patel
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicholas Bazett
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Grace Hey
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akhil Mandavali
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California-Irvine, Orange, California, USA
| | - Maxwell Woolridge
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
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2
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Zhu Y, Fan G, Cao L, Zhu H, Wu S, Zhao J, Zhou G. Survival outcomes of patients with brain metastasis of osteosarcoma can be improved by aggressive multi-disciplinary interventions including chemotherapy. Br J Neurosurg 2024; 38:654-659. [PMID: 34261400 DOI: 10.1080/02688697.2021.1950624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/OBJECTIVE Brain metastasis in osteosarcoma (BMO) is rare and its clinical characteristics are often buried among studies on brain metastasis of bone and soft tissue sarcomas. The aim of the present study was to summarize the incidence, clinical characteristics, treatment and outcomes of patients with BMO. METHODS This retrospective study included 7 patients with BMO who received treatment in our center between 2005 and 2019. The clinical medical records of the 7 patients, together with data of 70 BMO patients published in 33 articles and retrieved by means of PubMed and Medline, were analyzed, retrospectively. RESULTS Data analysis of the 97 BMO patients showed a high correlation between the interval from the primary diagnosis to BMO occurrence and the interval from the primary diagnosis to prior metastases. Multivariate analysis showed that chemotherapy, radiotherapy and surgery were three main factors affecting the overall survival of BMO patients (HR = 0.427; HR = 0.372; HR = 0.296). Surgery combined with chemotherapy or radiotherapy offered a better overall survival than surgery alone. CONCLUSION Patients with BMO may obtain survival benefits from regular neuroimaging and early aggressive multi-disciplinary interventions including surgical resection, postoperative radiotherapy and chemotherapy. SYNOPSIS This is a retrospective study describing the characteristics of metastasic intervals, locations, clinical features and prognosis in 97 patients with brain metastasis of osteosarcoma (BMO). Multivariate analysis showed that chemotherapy was effective as surgery and radiotherapy for the treatment of BMO. Our findings emphasize the importance of regular neuroimaging and early aggressive multi-disciplinary interventions including surgical resection, postoperative radiotherapy and chemotherapy.
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Affiliation(s)
- Yan Zhu
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Gentao Fan
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Lili Cao
- Jinling Hospital Department of Orthopaedics, Southeast University, Nanjing, China
| | - Hao Zhu
- Jinling Hospital Department of Orthopaedics, Nanjing University, Nanjing, China
| | - Sujia Wu
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Jianning Zhao
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
| | - Guangxin Zhou
- Jinling Hospital Department of Orthopaedics, Nanjing Medical University, Nanjing, China
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Jędrys W, Leśniak A, Borkowska A, Rutkowski P, Sobczuk P. Brain metastases of sarcoma: a rare phenomenon in rare tumours. J Cancer Res Clin Oncol 2023; 149:18271-18281. [PMID: 37994983 PMCID: PMC10725339 DOI: 10.1007/s00432-023-05451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 11/24/2023]
Abstract
The usual site for distant metastases of sarcoma is lungs, while brain metastasis (BM) occurs much less frequently and usually late in the disease progression. Despite the advancement in cancer treatment, the outcome for patients with brain metastasis is poor, and their lifespan is short. The frequency of BM in sarcoma seems to be affected by the location and histology of the primary tumour. Sarcoma subtypes with a high propensity for brain metastasis are ASPS, leiomyosarcoma and osteosarcoma. There are no clear guidelines for the treatment of sarcoma brain metastasis. However, therapeutic options include surgery, radiotherapy and chemotherapy, and are often combined. Targeted therapies are a promising treatment option for sarcoma but require investigation in patients with BM. The following review presents the data on sarcoma brain metastasis incidence, treatment and prognosis.
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Affiliation(s)
- Wiktoria Jędrys
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Leśniak
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Paweł Sobczuk
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Skłodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland.
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4
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Mackel CE, Rosenberg H, Varma H, Uhlmann EJ, Vega RA, Alterman RL. Intracranial Metastasis of Extracranial Chondrosarcoma: Systematic Review With Illustrative Case. Brain Tumor Res Treat 2023; 11:103-113. [PMID: 37151152 PMCID: PMC10172009 DOI: 10.14791/btrt.2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Cerebral chondrosarcoma metastases are rare and aggressive neoplasms. The rarity of presentation has precluded rigorous analysis of diagnosis, risk factors, treatment, and survival. We analyzed every reported case through exhaustive literature review. We further present the first case with Maffucci syndrome. METHODS Three databases, PubMed, Embase, and Google Scholar, and crossed references were queried for cerebral chondrosarcoma metastases. Extracted variables included demographics, risk factors, tumor characteristics, interventions, and outcomes. Univariate and multivariate analyses were performed. RESULTS Fifty-six patients were included from 1,489 literature results. The average age at brain metastasis was 46.6±17.6 years and occurred at a median of 24±2.8 months from primary diagnosis. Primary tumor histology (dedifferentiated 5.0±1.5 months, mesenchymal 24±3.0 months, conventional 41±7.4 months, p<0.05) and grade (low grade 54±16.7 months vs. high-grade 10±6.4 months, p<0.001) correlated with time interval until brain metastasis. A multiple enchondromatosis syndrome occurred in 13.2% of cases. At time of brain metastases diagnosis, extracranial metastases were identified in 76.2% of cases. Median survival after the development of brain metastasis was 2.0±0.78 months with a 1-year survival of 10.0%. On regression analysis, surgery reduced brain metastasis mortality risk and radiation trended towards reduced mortality risk (surgery: hazard ratio [HR] 0.22, 95% confidence interval [CI] 0.064-0.763, p=0.017; radiation: HR 0.31, 95% CI 0.091-1.072, p=0.064). CONCLUSION We present a systematic review of cerebral chondrosarcoma metastases. Primary tumor histology and grade correlate with time until cerebral metastasis. Following cerebral metastasis, these tumors have poor prognosis and modestly benefit from surgery.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA.
| | - Harry Rosenberg
- Department of Pathology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA
| | - Hemant Varma
- Department of Pathology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA
| | - Erik J Uhlmann
- Department of Neurology, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA
| | - Rafael A Vega
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron L Alterman
- Department of Neurosurgery, Beth Israel Deaconess Hospital and Harvard Medical School, Boston, MA, USA
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Wang Y, Delisle M, Smith D, Alshamsan B, Srikanthan A. Clinical outcomes of brain metastasectomy from soft tissue and bone sarcomas: a systematic review. Int J Clin Oncol 2022; 27:1767-1779. [PMID: 35994183 DOI: 10.1007/s10147-022-02227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Brain metastasis in sarcomas is associated with a poor prognosis. Data regarding prognostic factors and clinical outcomes of surgical resection of brain metastasis from sarcomas are limited. The objective of this systematic review was to evaluate survival outcomes post-brain metastasectomy for patients with soft tissue and bone sarcomas. METHODS A systematic review was conducted examining survival outcomes among adults and children with soft tissue and bone sarcoma undergoing brain metastasectomy, in the English language from inception up to May 31, 2021. Two reviewers independently evaluated and screened the literature, extracted the data, and graded the included studies. The body of evidence was evaluated and graded according to the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies and the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Results were synthesized using descriptive methods. A meta-analysis was not possible due to the low quality and heterogeneity of studies. RESULTS Ten studies published between 1994 and 2020 were included: three were retrospective cohort studies and seven were case series. 507 patients were included, of whom 269 underwent brain metastasectomy. The median follow-up period ranged between 14 and 29 months. The median survival period after metastasectomy ranged from 7 to 25 months. The most common prognostic factors associated with survival included presenting performance status, age, number of brain metastases, presence of lung metastases, and peri-operative radiation therapy administration. DISCUSSION Although the level of evidence is low, retrospective studies support that brain metastasectomy can be performed with reasonable post-operative survival in selected individuals.
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Affiliation(s)
- Ying Wang
- Division of Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 4E6, Canada
| | - Megan Delisle
- Division of Surgery, The Ottawa Hospital, Ottawa, ON, K1H8L6, Canada
| | - Denise Smith
- McMaster University, Health Sciences Library, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Bader Alshamsan
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine, College of Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Amirrtha Srikanthan
- Division of Medical Oncology, Department of Medicine, University of Ottawa, Ottawa, ON, K1H 8L6, Canada. .,Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,Ottawa Hospital Research Institute, Ottawa, ON, K1Y4E9, Canada.
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6
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CyberKnife Stereotactic Radiosurgery for an unusual case of large brain metastases from Ewing's sarcoma in a paediatric patient. Adv Radiat Oncol 2022; 7:100979. [PMID: 35814851 PMCID: PMC9260128 DOI: 10.1016/j.adro.2022.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 04/16/2022] [Indexed: 11/20/2022] Open
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Brain Metastases from Adult Sarcomas: A Retrospective Cohort Study from the Hellenic Group of Sarcomas and Rare Cancers (HGSRC). J Clin Med 2021; 10:jcm10245978. [PMID: 34945275 PMCID: PMC8704580 DOI: 10.3390/jcm10245978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022] Open
Abstract
Brain metastases are rare events in patients with sarcoma and the available information is relatively limited. We retrospectively reviewed medical records of patients with sarcoma who developed brain metastases between April 2010 and April 2020 in six centers. Thirty-four adult patients were included with a median age at brain metastases diagnosis of 55.5 years (range, 18–75). The primary sarcomas originated either from soft tissue (n = 27) or bone (n = 7) and the most common subtypes were leiomyosarcoma (n = 8), Ewing sarcoma/peripheral neuroectodermal tumor (PNET) (n = 7) and osteosarcoma (n = 3). Most primary tumors were of high grade and located mainly in the extremities (n = 18). The vast majority of patients at the time of brain metastasis diagnosis already had extracranial metastatic disease (n = 26). The median time from sarcoma diagnosis to cerebral metastasis diagnosis was 16 months (range, 1–136). Treatment modalities for brain metastatic disease included whole-brain radiation therapy (WBRT) (n = 22), chemotherapy (n = 17), exclusive palliative care (n = 5), surgery (n = 9), targeted therapy (n = 6) or stereotactic radiosurgery (n = 2). Most patients experienced a progression of brain metastases (n = 11). The median overall survival from brain metastasis diagnosis was 3 months (range, 0–80). OS was significantly influenced by time-to-brain metastases (p = 0.041), WBRT (p = 0.018), surgery (p = 0.002) and chemotherapy (p = 0.006). In a multivariate analysis, only the localization of the primary (p = 0.047) and WBRT (p = 0.038) were associated with survival with statistical significance. Patients with sarcoma brain metastases have a particularly poor prognosis and an appropriate therapeutic approach is yet to be defined.
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8
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Gusho CA, Blank AT, Batus M. Outcomes of brain metastasis in high-grade bone and soft tissue sarcoma: An analysis of clinicopathological characteristics and survival data. Rare Tumors 2021; 13:20363613211026151. [PMID: 34221290 PMCID: PMC8221671 DOI: 10.1177/20363613211026151] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
Brain metastases in sarcoma are exceedingly rare, with few published series documenting ranges from 1% to 8%. This study investigated the outcomes of sarcoma patients with brain metastases using a population-based analysis. This was a retrospective review of 5933 patients with high-grade sarcoma identified from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. Of the eligible 5933 patients, 0.7% (n = 44) had brain metastasis. Kaplan–Meier was used to estimate survival and follow-up (reverse Kaplan–Meier), and a multivariable Cox proportional hazards model analyzed prognostic factors of disease-free survival (DFS). Median (IQR) follow-up of all eligible patients was 28 months (12; 47). Patients who developed brain metastasis had a higher proportion of N1 stage disease (p < 0.001), as well as synchronous metastasis to bones, liver, and lungs compared to those without brain metastasis (all p < 0.001). The median (IQR) DFS with brain metastasis was 6 months (2; 12), and survival with brain metastasis was significantly worse than DFS in patients without brain metastasis (p < 0.001). Among those with brain metastasis only, there was no difference in DFS with respect to sex, race, primary tumor origin, T stage or N stage disease, synchronous metastasis to bone, liver or lung, nor with respect to chemotherapy or radiation for treatment of the primary tumor (all p > 0.05). For sarcoma patients with brain metastasis, the outcomes are poor and do not appear to differ by clinicopathologic factors. However, patients with certain histologies and synchronous metastases may warrant more frequent surveillance as there was an association of brain metastasis with these factors.
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Affiliation(s)
- Charles A Gusho
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Rush University Medical Center and Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Alan T Blank
- Division of Orthopedic Oncology, Department of Orthopedic Surgery, Rush University Medical Center and Midwest Orthopaedics at Rush, Chicago, IL, USA
| | - Marta Batus
- Division of Hematology, Oncology and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Poh JZ. Secondary brain metastases of Ewing's sarcoma presenting with collapse after 6 years of complete remission. Clin Case Rep 2021; 9:560-565. [PMID: 33489215 PMCID: PMC7813011 DOI: 10.1002/ccr3.3583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/19/2020] [Accepted: 10/30/2020] [Indexed: 11/08/2022] Open
Abstract
Routine brain imaging with MRI and long-term follow-up of Ewing's sarcoma could be the way to move forward by increasing our understanding in this area, as well as improving treatment and long-term outcome for patients.
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Affiliation(s)
- Jian Zi Poh
- Trauma and Orthopaedics DepartmentScunthorpe General HospitalScunthorpeUK
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10
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Deguchi S, Nakasu Y, Sakaida T, Akimoto J, Tanahashi K, Natsume A, Takahashi M, Okuda T, Asakura H, Mitsuya K, Hayashi N, Narita Y. Surgical outcome and graded prognostic assessment of patients with brain metastasis from adult sarcoma: multi-institutional retrospective study in Japan. Int J Clin Oncol 2020; 25:1995-2005. [PMID: 32648133 DOI: 10.1007/s10147-020-01740-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Brain metastasis (BM) is an uncommon complication of sarcomas with a poor prognosis. Little information is available about the feasibility and prognostic factors of surgical resection of BM from sarcomas. METHODS This study involved a retrospective analysis of 22 patients with BM from sarcomas who underwent resection at six institutes in Japan. Prognostic factors were analyzed to develop a graded prognostic assessment (GPA) using the log-rank test and Cox regression analysis. For validation of this GPA, we collected data on 100 surgical cases from 48 published reports. RESULTS Postoperative Karnofsky Performance Status (KPS) improved in 50% of our patients. Median overall survival (OS) was 21 months. Multivariate analysis showed age and alveolar soft part sarcoma (ASPS) were significant preoperative prognostic factors (P < 0.05). RTOG-RPA classification had no significant prognostic value. We developed a GPA system for OS after resection of BM. A score of 0 was assigned to patients aged 18-29 years with non-ASPS, 2 to patients aged 18-29 years with ASPS or 30-76 years with non-ASPS, and 4 to patients aged 30-76 years with ASPS. Median OS for patients with GPA scores of 0, 2, and 4 were 6.5, 16.0, and 44.0 months, respectively (P = 0.002). The results were validated by the data of 100 cases compiled (P < 0.001). CONCLUSION Median OS of patients with BM from sarcomas was comparable to that from carcinomas after resection. A new sarcoma-specific GPA may help patients and clinicians to select resection as an option for treatment of BM from sarcomas.
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Affiliation(s)
- Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Nagaizumi, Shizuoka, 411-8777, Japan.
| | - Yoko Nakasu
- Division of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Tsukasa Sakaida
- Division of Neurological Surgery, Chiba Cancer Center, Chiba, Japan
| | - Jiro Akimoto
- Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
| | - Takeshi Okuda
- Department of Neurosurgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hirofumi Asakura
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Nakamasa Hayashi
- Division of Neurosurgery, Shizuoka Cancer Center, 1007, Shimo-nagakubo, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center, Tokyo, Japan
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Chan CM, Lindsay AD, Spiguel AR, Scarborough MT, Gibbs CP. Brain metastases from Truncal and extremity bone and soft tissue sarcoma: Single institution study of oncologic outcomes. Rare Tumors 2020; 12:2036361320960060. [PMID: 33062230 PMCID: PMC7534074 DOI: 10.1177/2036361320960060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/26/2020] [Indexed: 12/26/2022] Open
Abstract
Brain metastases are a rare occurrence in patients with sarcoma. The prognosis for patients is poor, and treatment can contribute to considerable morbidity. We sought to examine the experience of our institution in managing these patients over a period of 17 years. We performed a retrospective cohort study of patients managed for sarcoma of the extremity or trunk who developed brain metastases from 2000 to 2017. Clinical data were analyzed and we assessed survival outcomes. 14 patients presenting at a mean age of 46.7 years were included. All patients were treated with radiotherapy for their brain metastases. 3 patients underwent surgical excision of their intracranial metastases. Two patients were treated with radium-223 dichloride. Kaplan–Meier survival analysis and the log rank test were used to calculate the survival probability, and to compare patient subgroups. All patients in this study developed lung or bone metastases at a mean interval of 13.3 months prior to the development of brain metastasis. The median interval from diagnosis of a brain metastasis to death was 3.6 months. The Kaplan–Meier survival probability at 6 months was 28.6%, and 14.3% at 1 year. Surgery was not found to be associated with increased survival. Patients with cerebellar metastasis had increased survival probability as compared to those with cerebral metastasis. Patients with extremity or trunk sarcoma who develop brain metastases frequently develop lung or bone metastases in the year preceding their diagnosis of brain metastasis. Patients with cerebellar metastasis may have better survival than those with cerebral metastasis, and an aggressive treatment approach should be considered. Despite aggressive treatment, the prognosis is grim.
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Affiliation(s)
- Chung Ming Chan
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Adam D Lindsay
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Andre Rv Spiguel
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Mark T Scarborough
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - C Parker Gibbs
- Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
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12
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Arakawa S, Asano Y, Kawabe N, Nagata H, Kondo Y, Furuta S, Shimura M, Hayashi C, Ochi T, Kamio K, Kawai T, Yasuoka H, Higashiguchi T, Ishihara S, Ito M, Imaeda Y, Horiguchi A. Resection of pancreatic and splenic metastases from alveolar soft part sarcoma: a case report. Surg Case Rep 2020; 6:139. [PMID: 32556799 PMCID: PMC7300166 DOI: 10.1186/s40792-020-00907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background We present a case of pancreatic and splenic metastases following alveolar soft part sarcoma (ASPS), which was successfully treated by surgery. Case presentation A 41-year-old male was referred to our hospital in 2012. Computed tomography (CT) showed the presence of a pancreatic tumor. In 2002, the patient had undergone surgical resection of an ASPS of the anal region. In 2009, during follow-up, CT revealed lung metastases, which prompted surgical resection of the lung, followed by resection of the head skin in 2011. Abdominal ultrasonography (US) revealed the presence of isodense masses sized 34 mm in the pancreatic head and 60 mm within the spleen. The contrast-enhanced US revealed a solitary lesion with enhancement. Contrast-enhanced CT revealed solitary lesions with enhancement within the pancreatic head, spleen, and liver. The patient underwent metastasectomies from the pancreas, spleen, and liver. The patient was discharged on postoperative day 22 without recurrence for 18 months after metastasectomy. Twelve years after primary resection and 2 years after metastasectomy, the patient died as a consequence of multiple metastases. Conclusions We have presented a rare case of pancreatic and spleen metastases from ASPS. Resection by radical metastasectomy was successful without morbidity. Thus, for improved survival of patients with multiple metastases from ASPS, metastasectomy may be indicated. If multiple metastases are resectable, surgical approaches may be the preferred treatment.
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Affiliation(s)
- Satoshi Arakawa
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan.
| | - Yukio Asano
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Norihiko Kawabe
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Hidetoshi Nagata
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yuka Kondo
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Shinpei Furuta
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Masahiro Shimura
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Chihiro Hayashi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Takayuki Ochi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Kenshiro Kamio
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Toki Kawai
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Hironobu Yasuoka
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Takahiko Higashiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Shin Ishihara
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Masahiro Ito
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Yoshihiro Imaeda
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, 3-6-10 Otobashi, Nakagawa-ku, Nagoya, Aichi, 454-8509, Japan
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13
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Cerebral metastasis from osteosarcoma: “Bone” in the brain. Radiol Case Rep 2020; 15:780-783. [PMID: 32322331 PMCID: PMC7171257 DOI: 10.1016/j.radcr.2020.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 11/23/2022] Open
Abstract
Although brain metastases from bone and soft tissue sarcoma are uncommon, advances in sarcoma treatment have led to an increasing incidence of them. We present a 23-year-old male with a history of metastatic femoral osteosarcoma, who presented with headache and unsteady gait and was diagnosed with a cerebellar metastasis. CT scan revealed a mass in the left cerebellar parenchyma with large intralesional central calcification and perilesional edema. Corticosteroid treatment led to neurological symptoms resolution, with a rapid tapering. The patient had also lung metastases and we opted to administer systemic treatment with the tyrosine kinase inhibitor cabozantinib. Given the relative radioresistance of osteosarcomas, the patient did not receive radiation therapy.
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Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy with a High Propensity for Brain Metastases. Sarcoma 2019; 2019:1960593. [PMID: 30962762 PMCID: PMC6431449 DOI: 10.1155/2019/1960593] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/14/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Primary cardiac sarcoma (PCS) has a poor prognosis compared to other sarcomas due to late presentation, challenging resection, incidence of metastases, and limited efficacy of systemic therapies. Methods A medical record search engine was queried to identify patients diagnosed with PCS from 1992 to 2017 at the University of Michigan. Results Thirty-nine patients with PCS had a median age of 41 years (range 2–77). Common histologies were angiosarcoma (AS, 14), high-grade undifferentiated pleomorphic sarcoma (UPS, 10), and leiomyosarcoma (LMS, 5). Sites of origin were left atrium (18), right atrium (16), and pericardium (5). AS was the most common right-sided tumor; UPS was more common on the left. Eighteen patients presented with metastases involving lung (10), bone (7), liver (5), and brain (4). Twenty-five patients underwent resection, achieving 3 R0 resections. Patients received a median of 2 (1–6) systemic therapies. Median overall survival (OS) was 12.1 months (range 0–79). Median OS was 14.0 months and 8.2 months in patients who did or did not undergo resection, respectively (p=0.018). Brain metastases occurred in 12 (31%) patients, 9 (75%) of whom had left heart tumors, at a median of 8.5 months (range 0–75) from diagnosis. Median OS was 5.6 months (range 0–30) after the diagnosis of brain metastases. Conclusions PCS portends a poor prognosis, because of difficulty in obtaining complete resection of sarcoma, advanced stage at diagnosis, and high risk of brain metastases. Providers should be aware of the increased risk of brain metastases and consider brain imaging at diagnosis and follow-up.
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15
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Chaigneau L, Patrikidou A, Ray-Coquard I, Valentin T, Linassier C, Bay JO, Moureau Zabotto L, Bompas E, Piperno-Neumann S, Penel N, Alcindor T, Laigre M, Guillemet C, Salas S, Hugli A, Domont J, Sunyach MP, Lecesne A, Blay JY, Nerich V, Isambert N. Brain Metastases from Adult Sarcoma: Prognostic Factors and Impact of Treatment. A Retrospective Analysis from the French Sarcoma Group (GSF/GETO). Oncologist 2018; 23:948-955. [PMID: 29934413 DOI: 10.1634/theoncologist.2017-0136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Brain metastases (BM) from adult soft tissue or bone sarcomas are rare, and sparse data exist on their prognostic factors and management. SUBJECTS, MATERIALS AND METHODS A retrospective study was conducted in 15 centers of the French Sarcoma Group, plus one Canadian and one Swiss center, to report on clinical, histological, and treatment characteristics and to identify predictive factors of outcome. RESULTS Between 1992 and 2012, 246 patients with a median age of 50 years (range: 16-86) were managed for BM. BM included 221 cerebral and cerebellar metastases and 40 cases of meningeal sarcomatosis. The most frequent histopathological subtype was leiomyosarcoma (18.7%). Histological grade was high in 118 (48%) cases. Surgery of BM was carried out for 38 (15.5%) patients. Radiotherapy and chemotherapy were administered in 168 (68.3%) and 91 (37.0%) patients, respectively. Irrespective of treatment modality, BM were controlled in 113 patients (45.9%), including 31 partial responses (12.6%) and 18 complete responses (7.3%). The median overall survival from diagnosis of brain metastasis was 2.7 months (range: 0-133). In the multivariate analysis, the following parameters influenced overall survival: chemotherapy (hazard ratio [HR] = 0.38; 95% confidence interval [CI]: 0.26-0.48), surgery (HR = 0.40; 95% CI: 0.22-0.72), stereotactic radiotherapy (HR = 0.41; 95% CI: 0.19-0.90), whole-brain radiotherapy (HR = 0.51; 95% CI: 0.35-0.76), and grade (HR = 0.65; 95% CI: 0.43-0.98). CONCLUSION BM of sarcomas are rare and associated with a dismal outcome. Multidisciplinary management with chemotherapy, radiation therapy, and surgery is associated with a better survival. IMPLICATIONS FOR PRACTICE The incidence of brain and meningeal metastasis in bone and soft tissue sarcomas is estimated between 1% and 8%. Published data are derived from small retrospective case series, often in the pediatric population. A prognostic index is important to guide both clinical decision-making and outcomes research, but one such is lacking for adult sarcoma patients with brain metastases. The current study describes brain metastasis in a large cohort of sarcoma patients. This study, conducted within the French Sarcoma Group, describes the natural history of sarcoma brain metastasis and enables the proposal of strategic recommendations for subsequent clinical trials and for the management of such patients.
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Affiliation(s)
- Loïc Chaigneau
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France
| | - Anna Patrikidou
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | | | - Claude Linassier
- Department of Medical Oncology, University Hospital, Tours, France
| | - Jacques Olivier Bay
- Department of Medical Oncology, University Hospital, Clermont-Ferrand, France
| | | | - Emmanuelle Bompas
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | | | - Nicolas Penel
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Thierry Alcindor
- Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - Maryline Laigre
- Department of Oncology, Centre Val D'Aurelle II, Montpelier, France
| | - Cecile Guillemet
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Sebastien Salas
- Department of Medical Oncology, CH La Timone, Marseille, France
| | | | - Julien Domont
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Axel Lecesne
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean Yves Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital Jean Minjoz, Besançon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
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16
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Pojskic M, Bopp MHA, Schymalla M, Nimsky C, Carl B. Retrospective study of 229 surgically treated patients with brain metastases: Prognostic factors, outcome and comparison of recursive partitioning analysis and diagnosis-specific graded prognostic assessment. Surg Neurol Int 2017; 8:259. [PMID: 29184710 PMCID: PMC5680662 DOI: 10.4103/sni.sni_228_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/26/2017] [Indexed: 01/18/2023] Open
Abstract
Background: Metastases are the most frequent tumors in the brain. Most often used scoring systems to predict the outcome are the RPA (Recursive Partitioning Analysis) classification and the DS-GPA (Diagnosis-Specific Graded Prognostic Assessment) score. The goal of our study was to determine prognostic factors which influence outcome in patients who undergo surgery for brain metastases and to compare different outcome scores. Methods: Two hundred and twenty-nine patients who underwent surgery for brain metastases in our institution between January 2005 and December 2014 were included in the study. Patient data were evaluated retrospectively. Results: The mean survival time was 19.2 months (median survival time, MST: 8 months), for patients with a single metastasis (n = 149) 17.6 months (MST: 8 months), and for patients with multiple metastases (n = 80) 17.9 months (MST: 6 months). Significant influence on MST had age <65 years (9 vs. 5 months, P = 0.002), female sex (10 vs. 6 months, P < 0.001), RPA Class I and II (11 vs. 4 months, P < 0.001), Karnofsky score >70% (11 vs. 4 months, P < 0.001), and postoperative radiotherapy (8 vs. 5 months, P < 0.002). To evaluate the diagnostic power of DS-GPA and RPA score in respect of survival, two Cox regressions were modeled, where the RPA classification showed a better predictive power. Conclusion: Favorable factors for prolonged survival were KPS >70%, RPA Class I and II, age <65 years, female sex, a DS-GPA Score of 2.5–3 and 3.5–4, and adjuvant radiotherapy. The RPA Classification was more accurate in predicting the outcome than the DS-GPA score.
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Affiliation(s)
- Mirza Pojskic
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Miriam H A Bopp
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Markus Schymalla
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
| | - Barbara Carl
- Department of Neurosurgery, Philipps-University Marburg, Baldingerstraβe, Germany
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17
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Al Sannaa G, Watson KL, Olar A, Wang WL, Fuller GN, McCutcheon I, Torres KE, Lazar AJ. Sarcoma Brain Metastases: 28 Years of Experience at a Single Institution. Ann Surg Oncol 2016; 23:962-967. [PMID: 27646022 DOI: 10.1245/s10434-016-5559-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Brain metastasis from sarcoma is rare, thus limited information is available. We examined sarcoma brain metastases diagnosed at our institution over a period of 28 years. METHODS This is a retrospective study of 112 cases. Clinical records were reviewed and clinical, pathological, and survival data were tabulated. RESULTS Undifferentiated sarcoma was the most common source. In 50 % of cases, the primary sarcoma was in the extremities. Most patients were adults at the time of first brain metastasis, and median age was 34.8 years. Although most patients evidenced metastatic disease to other sites prior to developing brain metastasis, in almost one quarter, brain was the initial site. Most of the metastatic foci were parenchymal, nonhemorrhagic, and solitary. Forty percent of the brain metastatic deposits were located in the frontal lobes. Thirty-one percent recurred-all within 5.3 years. Seventy-six percent of patients succumbed to the disease, with a median survival time of only 0.6 years. Hemorrhagic metastatic foci were found to be associated with significantly lower recurrence-free, as well as disease-specific survivals. No difference in survival was noted between single versus multiple deposits or primary soft tissue versus bone sarcomas. No statistically significant effect on survival was found when neurosurgical resection was combined with radiotherapy. Chemotherapy, on the other hand, was found to significantly improve disease-specific survival when combined with metastasectomy. CONCLUSIONS Undifferentiated sarcoma was the most common source of brain metastasis. Most cases showed evidence of prior metastatic disease. Surgical resection is employed to manage symptoms, but prognosis remains dismal.
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Affiliation(s)
- Ghadah Al Sannaa
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelsey L Watson
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adriana Olar
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ian McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keila E Torres
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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18
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Postoperative brain metastases in soft tissue sarcomas. Clin Exp Metastasis 2015; 32:345-51. [PMID: 25795392 DOI: 10.1007/s10585-015-9713-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
Brain metastases (BMs) from soft tissue sarcoma (STS) are rare but lethal. We reviewed 187 consecutive patients with STS treated with definitive surgery in Nagoya University Hospital from 2004 to 2014. There were 10 patients with neurofibromatosis-1 (NF-1). We investigated estimated brain metastasis free survival (BMFS) after surgery and overall survival (OS) after BMs in STS. The factors that affected BMFS were also investigated. Eight of 187 patients (4.3%) developed BM with a median period of 18.2 (range 8.8-42.6) months after surgery. Seven of 8 BM patients had metastases at other sites. Estimated 5 year BMFS rate after surgery was 95.2%, and 3 month OS rate after BM was 25.0%. NF-1 (p<0.0001), histological subtype of MPNST (p=0.008), and primary tumor size≥5 cm (p=0.021) were significantly associated with increasing incidence of BM. In this study, postoperative BMs were common in patients with NF-1, MPNST, and large tumors. Considering the impact of NF-1 on BMFS, careful follow up for BM is necessary for NF-1 patients with metastases at other sites.
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19
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Grossman R, Ram Z. Recursive Partitioning Analysis (RPA) Classification Predicts Survival in Patients with Brain Metastases from Sarcoma. World Neurosurg 2014; 82:1291-4. [DOI: 10.1016/j.wneu.2014.07.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 06/15/2014] [Accepted: 07/29/2014] [Indexed: 11/16/2022]
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20
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Shweikeh F, Bukavina L, Saeed K, Sarkis R, Suneja A, Sweiss F, Drazin D. Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes. Sarcoma 2014; 2014:475175. [PMID: 24757391 PMCID: PMC3976890 DOI: 10.1155/2014/475175] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/19/2014] [Accepted: 01/22/2014] [Indexed: 12/15/2022] Open
Abstract
Bone and soft tissue malignancies account for a small portion of brain metastases. In this review, we characterize their incidence, treatments, and prognosis. Most of the data in the literature is based on case reports and small case series. Less than 5% of brain metastases are from bone and soft tissue sarcomas, occurring most commonly in Ewing's sarcoma, malignant fibrous tumors, and osteosarcoma. Mean interval from initial cancer diagnosis to brain metastasis is in the range of 20-30 months, with most being detected before 24 months (osteosarcoma, Ewing sarcoma, chordoma, angiosarcoma, and rhabdomyosarcoma), some at 24-36 months (malignant fibrous tumors, malignant peripheral nerve sheath tumors, and alveolar soft part sarcoma), and a few after 36 months (chondrosarcoma and liposarcoma). Overall mean survival ranges between 7 and 16 months, with the majority surviving < 12 months (Ewing's sarcoma, liposarcoma, malignant fibrous tumors, malignant peripheral nerve sheath tumors, angiosarcoma and chordomas). Management is heterogeneous involving surgery, radiosurgery, radiotherapy, and chemotherapy. While a survival advantage may exist for those given aggressive treatment involving surgical resection, such patients tended to have a favorable preoperative performance status and minimal systemic disease.
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Affiliation(s)
- Faris Shweikeh
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Laura Bukavina
- Department of Medicine, Summa Health System, Akron, OH 44303, USA
- Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
| | - Kashif Saeed
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, IL 60612, USA
| | - Reem Sarkis
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Aarushi Suneja
- College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA
| | - Fadi Sweiss
- Department of Neurosurgery, George Washington University, Washington, DC 20037, USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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21
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Kirkpatrick JP, Kelsey CR, Palta M, Cabrera AR, Salama JK, Patel P, Perez BA, Lee J, Yin FF. Stereotactic body radiotherapy: a critical review for nonradiation oncologists. Cancer 2013; 120:942-54. [PMID: 24382744 DOI: 10.1002/cncr.28515] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/11/2013] [Accepted: 11/12/2013] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiotherapy (SBRT) involves the treatment of extracranial primary tumors or metastases with a few, high doses of ionizing radiation. In SBRT, tumor kill is maximized and dose to surrounding tissue is minimized, by precise and accurate delivery of multiple radiation beams to the target. This is particularly challenging, because extracranial lesions often move with respiration and are irregular in shape, requiring careful treatment planning and continual management of this motion and patient position during irradiation. This review presents the rationale, process workflow, and technology for the safe and effective administration of SBRT, as well as the indications, outcome, and limitations for this technique in the treatment of lung cancer, liver cancer, and metastatic disease.
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Affiliation(s)
- John P Kirkpatrick
- Department of Radiation Oncology, Duke Cancer Institute, and the Durham VA Medical Center, Durham, North Carolina
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22
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Oermann EK, Kress MAS, Todd JV, Collins BT, Hoffman R, Chaudhry H, Collins SP, Morris D, Ewend MG. The impact of radiosurgery fractionation and tumor radiobiology on the local control of brain metastases. J Neurosurg 2013; 119:1131-8. [DOI: 10.3171/2013.8.jns122177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Experience with whole-brain radiation therapy for metastatic tumors in the brain has identified a subset of tumors that exhibit decreased local control with fractionated regimens and are thus termed radioresistant. With the advent of frameless radiosurgery, fractionated radiosurgery (2–5 fractions) is being used increasingly for metastatic tumors deemed too large or too close to crucial structures to be treated in a single session. The authors retrospectively reviewed metastatic brain tumors treated at 2 centers to analyze the dependency of local control rates on tumor radiobiology and dose fractionation.
Methods
The medical records of 214 patients from 2 institutions with radiation-naive metastatic tumors in the brain treated with radiosurgery given either as a single dose or in 2–5 fractions were analyzed retrospectively. The authors compared the local control rates of the radiosensitive with the radioresistant tumors after either single-fraction or fractionated radiosurgery.
Results
There was no difference in local tumor control rates in patients receiving single-fraction radiosurgery between radioresistant and radiosensitive tumors (p = 0.69). However, after fractionated radiosurgery, treatment for radioresistant tumors failed at a higher rate than for radiosensitive tumors with an OR of 5.37 (95% CI 3.83–6.91, p = 0.032).
Conclusions
Single-fraction radiosurgery is equally effective in the treatment of radioresistant and radiosensitive metastatic tumors in the brain. However, fractionated stereotactic radiosurgery is less effective in radioresistant tumor subtypes. The authors recommend that radioresistant tumors be treated in a single fraction when possible and techniques for facilitating single-fraction treatment or dose escalation be considered for larger radioresistant lesions.
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Affiliation(s)
- Eric K. Oermann
- 1Departments of Neurosurgery and
- 2Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Marie-Adele S. Kress
- 2Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Jonathan V. Todd
- 3North Carolina Translational and Clinical Sciences Institute, The University of North Carolina at Chapel Hill, North Carolina; and
| | - Brian T. Collins
- 2Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | | | - Huma Chaudhry
- 2Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Sean P. Collins
- 2Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
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23
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Chua C, Raaj J, Pan S, Farid M, Lee JFM, Ho ZC, Sairi A, Sittampalam K, Tao M, Tay K, Lim ST, Chin F, Teo M, Quek R. Brain metastasis in sarcoma: Does metastasectomy or aggressive multi-disciplinary treatment improve survival outcomes. Asia Pac J Clin Oncol 2013; 12:e16-22. [PMID: 23937339 DOI: 10.1111/ajco.12111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Brain metastasis is rare in sarcoma. Prognostic factors, optimal management strategies and therapeutic outcomes of such patients are not well studied. We aimed to evaluate the incidence, clinical characteristics and treatment outcomes of parenchymal brain metastasis in sarcoma patients. METHODS This is a single center retrospective analysis. Overall survival (OS) was calculated from the time of diagnosis of brain metastasis to time of death. RESULTS Sixteen patients (2.1%) with complete electronic medical records treated at our institution from 2002 to 2010 were identified. Median age was 52 years; 88% had additional sites of metastases. Eight different subtypes of soft tissue and bone sarcoma were identified. Eighty-one percent of the patients developed metachronous brain metastasis at a median of 14 months after initial sarcoma diagnosis. Thirty-eight percent of patients had solitary brain metastasis and 44% underwent aggressive therapy for brain metastasis, defined as either surgical resection or multimodality treatment. The remaining 56% received conservative treatment (either whole brain radiation alone, chemotherapy alone or best supportive care). Median OS for the entire cohort was 3.5 months (95% CI 1.1-6.3 months). A trend toward improved OS was observed with an aggressive treatment approach, 3.7 months versus 1.2 months (P = 0.077) and the usage of chemotherapy (P = 0.071). CONCLUSION Brain metastasis in sarcoma is rare, usually coexists with significant systemic disease and is associated with a grave prognosis. Use of chemotherapy and an aggressive treatment approach in well-selected patients may be associated with improved survival. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Clarinda Chua
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jeevan Raaj
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Summer Pan
- Biostatistics Unit, Clinical Trials and Epidemiology, National Cancer Centre Singapore, Singapore
| | - Mohamad Farid
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Jin Fu Marcus Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhen Chong Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alisa Sairi
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Miriam Tao
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kevin Tay
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soon Thye Lim
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Francis Chin
- Department of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Melissa Teo
- Department of Surgical Oncology, National Cancer Centre Singapore, Singapore
| | - Richard Quek
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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24
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Kaduri S, Tampieri D. Leiomyosarcoma Leptomeningeal Brain Metastases. Neuroradiol J 2012; 25:587-92. [PMID: 24029094 DOI: 10.1177/197140091202500512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 09/23/2012] [Indexed: 11/16/2022] Open
Abstract
Brain metastases from soft tissue sarcomas (STS) occur late and relatively rarely, most commonly after lung metastases have developed. Furthermore, they are most commonly intraparenchymal in distribution. We describe two cases of histologically confirmed intracranial metastatic soft tissue leiomyosarcomas. In both cases all the nodular metastases measuring 10 mm in diameter or less could be easily detected in the leptomeningeal spaces by MRI. However, as the lesion enlarges it is difficult to recognize the site of origin, and the mass appears and behaves as intra-axial. Lesions located in the leptomeningeal spaces and in the perivascular space can be extremely small, which makes their detection problematic. For this reason we believe that in this context, MRI global gadolinium enhanced imaging using contiguous 1 mm slice thickness acquisition (TR 23 ms, TE 8 ms 512×512 matrix) is preferable, since the patient's management may vary depending on the multiplicity and location of the lesions.
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Affiliation(s)
- S. Kaduri
- McGill University Health Centre; Montreal, Canada
| | - D. Tampieri
- Department of Neuroradiology, Montreal Neurological Hospital and Institute; Montreal, Canada
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Shin TH, Jung YJ, Kim OL, Kim MS. Alveolar soft part sarcoma metastasized to both the skull and the brain. J Korean Neurosurg Soc 2012; 52:55-7. [PMID: 22993680 PMCID: PMC3440505 DOI: 10.3340/jkns.2012.52.1.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/16/2012] [Accepted: 07/06/2012] [Indexed: 11/27/2022] Open
Abstract
Alveolar soft part sarcoma (ASPS) with skull and brain metastases is extremely rare. A 53-year-old patient diagnosed as skull metastasis of ASPS visited our clinic complaining of an outgrowing scalp mass in spite of radiation therapy. Past medical history revealed that the patient had been diagnosed and treated for ASPS of the thigh 4 years ago. Magnetic resonance imaging revealed a hyperintense ovoid mass on the T2-weighted image, an isointense on the T1-weighted image, and a homogeneous enhanced mass with gadolinium. Another small-sized enhanced mass with mild peritumoral swelling was found at the deep white matter of the left frontal lobe. A gross total resection of the skull lesion with cranioplasty was performed for the surgical defect. A histologic examination of the specimens revealed metastatic ASPS involving the skull. Surgery with a total removal of the lesions may be effective for improving a patient's symptoms especially from neurological dysfunction.
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Affiliation(s)
- Tae-Hee Shin
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Young-Jin Jung
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Oh-Lyong Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Min-Su Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
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Chargari C, Kaloshi G, Benouaich-Amiel A, Lahutte M, Hoang-Xuan K, Ricard D. Metastasi cerebrali. Neurologia 2012. [DOI: 10.1016/s1634-7072(12)62058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Gupta T, Laskar S, Gujral S, Muckaden MA. Brain metastases in soft tissue sarcomas: case report and literature review. Sarcoma 2011; 9:147-50. [PMID: 18521423 PMCID: PMC2395633 DOI: 10.1080/13577140500190921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background and purpose: Brain metastasis is a relatively uncommon event in the natural history of soft tissue sarcomas.
The increasing use of chemotherapy may have caused a reduction in local relapses as well as distant failures leading to an
improvement in survival, thereby allowing metachronous seeding of the brain, a sanctuary site. The purpose of this report is
to increase awareness amongst clinicians regarding such a possibility. Patients and methods: A review of the departmental sarcoma database following the presentation of this index case in the
clinic. Results and discussion: An adolescent male who had previously been treated with surgery and radiotherapy for a spindle cell
sarcoma of the left thigh developed a space-occupying lesion in the brain within 6 months of treatment of the primary
tumor. He subsequently underwent resection of the presumed solitary brain metastasis followed by whole brain
radiotherapy. On radiation he was detected to have pulmonary metastases too, for which he was offered palliative
chemotherapy. The patient died of brain metastasis within 4 months. A review of the departmental sarcoma database,
restricted to soft tissue sarcomas purely, maintained prospectively from 2000 till date, could not identify any other such
case. Conclusion: Brain metastases from soft tissue sarcomas are rare. Patients with neurological symptoms, however, should
be appropriately investigated. Surgical resection of brain metastasis could be considered for solitary brain metastasis
in non-eloquent areas. Palliative radiotherapy is appropriate for patients with multiple brain metastases or co-existing
extra-cranial disease.
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Affiliation(s)
- Tejpal Gupta
- Tata Memorial Centre Institute Tata Memorial Centre Mumbai India
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29
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Chou YS, Liu CY, Chen WM, Chen TH, Chen PCH, Wu HTH, Shiau CY, Wu YC, Liu CL, Chao TC, Tzeng CH, Wong TT, Yen CC. Brain, the last fortress of sarcoma: Similar dismal outcome but discrepancy of timing of brain metastasis in bone and soft tissue sarcoma. J Surg Oncol 2011; 104:765-70. [DOI: 10.1002/jso.22011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/08/2011] [Indexed: 12/21/2022]
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Osawa SI, Kumabe T, Saito R, Sonoda Y, Niizuma H, Watanabe M, Tominaga T. Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports. Brain Tumor Pathol 2011; 28:167-74. [DOI: 10.1007/s10014-010-0014-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
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Tanaka H, Sasayama T, Nishihara M, Arai A, Kawamura A, Kanomata N, Itoh T, Kohmura E. Brain metastasis of undifferentiated sarcoma and response to temozolomide treatment. Case report. Neurol Med Chir (Tokyo) 2011; 50:689-93. [PMID: 20805657 DOI: 10.2176/nmc.50.689] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 33-year-old woman presented with rare brain metastases from undifferentiated high-grade sarcoma manifesting as headache and vomiting. Magnetic resonance (MR) imaging demonstrated multiple tumors in the brain, subcutaneous soft tissue, and mediastinum. The patient underwent surgery, followed by chemotherapy and radiotherapy. The histological diagnosis was undifferentiated high-grade sarcoma. Radiotherapy was effective, but the brain tumors recurred 6 months later. The patient underwent high-dose methotrexate therapy, but showed no response. Promoter hypermethylation in the O(6)-methylguanine-deoxyribonucleic acid methyltransferase (MGMT) genes was detected and MGMT protein expression was negative in the recurrent tumor, so temozolomide (TMZ) salvage chemotherapy was given, and follow-up MR imaging showed tumor reduction. This case suggests that TMZ may be effective for brain metastasis of undifferentiated sarcoma without MGMT protein expression.
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Affiliation(s)
- Hirotomo Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo
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Salvati M, D'Elia A, Frati A, Santoro A. Sarcoma metastatic to the brain: a series of 35 cases and considerations from 27 years of experience. J Neurooncol 2009; 98:373-7. [PMID: 20039192 DOI: 10.1007/s11060-009-0085-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 11/30/2009] [Indexed: 10/20/2022]
Abstract
The authors report their 27-year experience regarding 35 cases of supratentorial brain metastasis from sarcoma treated in a single institution: these included ten osteosarcomas, seven leiomyosarcomas, five Ewing sarcomas, four malignant fibrous histiocytomas, three alveolar soft-part sarcomas (ASPS), two rhabdomyosarcomas, one liposarcoma, and three unclassified sarcomas. The first 15 cases of the series have already been described in a previous publication. Median survival after craniotomy was 9.8 months (range: 4-24). In patients with preoperative Karnofsky performance score (KPS) > 60 it was 12.8 months (range: 6.5-24 months) versus 5.4 months for those patients with a KPS < or = 60 (P = 0.01). Eight patients had more than one lesion, six of which were treated in the last ten years. Of the three patients with ASPS, the first two were alive at 15 and 20 months (before being lost to follow-up) whereas the third patient is alive at 24 month follow-up. The authors conclude that surgery is more effective in treating selected patients with sarcoma metastatic to the brain, and that patients with metastasis from ASPS have good prognosis when submitted to surgical treatment. The complete removal of all brain metastases "en bloc" and a KPS > 60 are associated with the best prognosis. Finally, it seems that surgical indications for multiple brain metastases from sarcoma have increased during the last ten years.
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Affiliation(s)
- M Salvati
- Neuroscience-Neurosurgery Department, "Sapienza" University, Rome, Italy.
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Flannery T, Kano H, Niranjan A, Monaco EA, Flickinger JC, Kofler J, Lunsford LD, Kondziolka D. Gamma knife radiosurgery as a therapeutic strategy for intracranial sarcomatous metastases. Int J Radiat Oncol Biol Phys 2009; 76:513-9. [PMID: 19467792 DOI: 10.1016/j.ijrobp.2009.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 01/21/2009] [Accepted: 02/02/2009] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the indication and outcomes for Gamma Knife stereotactic radiosurgery (GKSRS) in the care of patients with intracranial sarcomatous metastases. METHODS AND MATERIALS Data from 21 patients who underwent radiosurgery for 60 sarcomatous intracranial metastases (54 parenchymal and 6 dural-based) were studied. Nine patients had radiosurgery for solitary tumors and 12 for multiple tumors. The primary pathology was metastatic leiomyosarcoma (4 patients), osteosarcoma (3 patients), soft-tissue sarcoma (5 patients), chondrosarcoma (2 patients), alveolar soft part sarcoma (2 patients), and rhabdomyosarcoma, Ewing's sarcoma, liposarcoma, neurofibrosarcoma, and synovial sarcoma (1 patient each). Twenty patients received multimodality management for their primary tumor, and 1 patient had no evidence of systemic disease. The mean tumor volume was 6.2 cm(3) (range, 0.07-40.9 cm(3)), and a median margin dose of 16 Gy was administered. Three patients had progressive intracranial disease despite fractionated whole-brain radiotherapy before SRS. RESULTS A local tumor control rate of 88% was achieved (including patients receiving boost, up-front, and salvage SRS). New remote brain metastases developed in 7 patients (33%). The median survival after diagnosis of intracranial metastasis was 16 months, and the 1-year survival rate was 61%. CONCLUSIONS Gamma Knife radiosurgery was a well-tolerated and initially effective therapy in the management of patients with sarcomatous intracranial metastases. However, many patients, including those who also received fractionated whole-brain radiotherapy, developed progressive new brain disease.
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Affiliation(s)
- Thomas Flannery
- Department of Neurological Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Fox BD, Patel A, Suki D, Rao G. Surgical management of metastatic sarcoma to the brain. J Neurosurg 2009; 110:181-6. [PMID: 18834268 DOI: 10.3171/2008.4.17505] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECT Metastatic sarcoma to the brain is rare and represents a therapeutic challenge due to its relative resistance to radio- and chemotherapy. Resection has traditionally been the mainstay of treatment. The authors reviewed a series of patients with metastatic sarcoma to the brain treated surgically to determine outcomes and identify predictors of survival in these patients. METHODS A retrospective review of prospectively collected data was undertaken on patients undergoing surgery between 1993 and 2005 for metastatic sarcoma to the brain at The University of Texas, M.D. Anderson Cancer Center. RESULTS During the study period, 62 patients underwent 84 operations for metastatic sarcoma to the brain. The median postoperative overall and progression-free survival rates were 7.5 and 4.7 months, respectively. Fifty-nine (95%) of 62 patients had a gross-total resection. The 30-day mortality rate was 4.2%. The Karnofsky Performance Scale scores at discharge from the hospital and 3 months postoperatively were the same or improved in 50 (85%) of 59 and 26 (51%) of 51, respectively. Overall postcraniotomy survival was 62% at 6 months, 39% at 1 year, 21% at 2 years, and 8% at 5 years. In multivariate and univariate analysis, control of systemic disease, and sarcomas originating from bone, cartilage, or soft tissue were predictors of survival. Patients with control of systemic disease had survival advantage when compared with those who did not. In patients with alveolar soft-part sarcoma, there was a significantly increased survival advantage compared with all other histological subgroups. CONCLUSIONS The authors' results suggest that in selected patients, resection of metastatic sarcoma to the brain is associated with a relatively low risk of operative death and results in improvement in neurological function. Patients with systemic control of their primary disease and certain histological subtypes (specifically alveolar soft-part sarcoma) have improved overall and progression-free survival.
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Affiliation(s)
- Benjamin D Fox
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Houston, Texas, USA
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Report of eight recent cases of locally advanced primary pulmonary artery sarcomas: failure of Doxorubicin-based chemotherapy. J Thorac Oncol 2008; 3:907-11. [PMID: 18670310 DOI: 10.1097/jto.0b013e318180720d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Case reports of primary pulmonary artery sarcomas are very rare. METHODS We described herein eight new cases diagnosed between December 2000 and December 2004. RESULTS There were four men and four women, with median age of 52 years. Presenting symptoms mimicked pulmonary emboli in all cases. There were six "intimal sarcomas" and two leiomyosarcomas. In six cases, we observed initial metastasis in lung (six cases), in bone (two cases), and in brain (two cases), and adrenal gland (one case). The palliative treatments included surgical desobstruction (six cases), conformational radiotherapy (four cases), and chemotherapy (seven cases). Doxorubicin-based regimen failed in seven cases. All patients died (median survival: 8 months, extremes 5-20 months). CONCLUSION Those eight cases illustrate the high incidence of initial metastasis and the very poor outcome of primary pulmonary artery sarcomas despite classic doxorubicin-based chemotherapy.
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Fowler A, Cook R, Biggs M, Little N, Assaad N, McDonald K. Survival of patients following neurosurgical treatment of colorectal adenocarcinoma metastasis in the Northern Sydney–Central Coast area. J Clin Neurosci 2008; 15:998-1004. [DOI: 10.1016/j.jocn.2007.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 11/24/2022]
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Honeybul S, Ha T. Leiomyosarcoma of the uterus metastatic to the brain: a case report. Arch Gynecol Obstet 2008; 279:391-3. [DOI: 10.1007/s00404-008-0717-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 06/12/2008] [Indexed: 10/21/2022]
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Abstract
Brain metastases seem to be an almost inevitable complication in patients with metastatic melanoma. Except for the rare patients who can undergo successful surgical resection of brain metastases, current management strategies do not appear adequate and result in a poor outcome (median survival, 2-4 months). In recent small series, stereotactic radiosurgery or gamma-knife treatment has suggested improvement in local control compared with whole brain radiation therapy. We have recently shown prolonged survival (11.1 months) using a multimodality treatment approach in 44 sequential patients with melanoma brain metastases. A subsequent study demonstrated that the outcome of biochemotherapy for metastatic melanoma is not affected by the presence or absence of brain metastases. Our results suggest that the outcome of patients with melanoma brain metastases can be improved using a multidisciplinary management strategy.
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Affiliation(s)
- Martin Majer
- Section of Melanoma, Renal Cancer and Immunotherapy, Nevada Cancer Institute, One Breakthrough Way, 10441 W. Twain Avenue, Las Vegas, NV 89135, USA
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Abstract
Brain metastases are the most common intracranial tumors in adults and source of the most common neurological complications of systemic cancer. The treatment approach to brain metastases differs essentially from treatment of systemic metastases due to the unique anatomical and physiological characteristics of the brain. Surgery and radiosurgery are important components in the complex treatment of brain metastases and can prolong survival and improve the quality of life (QOL). Aggressive intervention may be indicated for selected patients with well-controlled systemic cancer and good performance status in whom central nervous system (CNS) disease poses the greatest threat to functionality and survival. In this review the respective roles of surgery and radiosurgery, patient selection, general prognostic factors and tailoring of optimal surgical management strategies for cerebral metastases are discussed.
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Affiliation(s)
- Andrew A Kanner
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
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Ferguson M, Stewart W, Cowie F, White J. Late-onset meningeal metastases in liposarcoma: a case report and review of the literature. Sarcoma 2006; 2006:23039. [PMID: 17496993 PMCID: PMC1779505 DOI: 10.1155/srcm/2006/23039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 09/22/2006] [Accepted: 10/02/2006] [Indexed: 11/18/2022] Open
Abstract
Intracranial metastases from liposarcoma are rare and almost always preceded by the development of systemic tumour spread. We report here a case of liposarcoma with spread to the cranial nervous system 23 years after treatment of the primary tumour. The literature on brain metastases from soft tissue sarcoma is also reviewed.
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Affiliation(s)
- Michelle Ferguson
- Department of Oncology, Ninewells Hospital and Medical School, Ward 32, Dundee DD1 9SY, UK
- *Michelle Ferguson:
| | - William Stewart
- Department of Neuropathology, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - Fiona Cowie
- Beatson Oncology Centre, Dumbarton Road, North Glasgow University Hospitals Division, Glasgow G11 6NT, Scotland, UK
| | - Jeff White
- Beatson Oncology Centre, Dumbarton Road, North Glasgow University Hospitals Division, Glasgow G11 6NT, Scotland, UK
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Sandruck J, Escobar P, Lurain J, Fishman D. Uterine leiomyosarcoma metastatic to the sphenoid sinus: a case report and review of the literature. Gynecol Oncol 2004; 92:701-4. [PMID: 14766270 DOI: 10.1016/j.ygyno.2003.10.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2003] [Indexed: 11/27/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) of the uterus is a rare neoplasm with an aggressive growth pattern. Although the majority of uterine LMS is diagnosed with disease confined to the uterus, the rate of recurrent disease is high. The most common sites of recurrent disease are lung, liver, and peritoneal cavity. The rate of lymph node involvement with disease confined to the uterus is less than 3%. Metastases to brain and skull are rare. CASE A 39-year-old woman underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node biopsies, omentectomy, and appendectomy for Grade 2 FIGO Stage 1 uterine leiomyosarcoma. She remained disease-free for 2 years until she presented with metastases to the sphenoid sinus. She underwent incomplete resection of the recurrence and was treated postoperatively with adjuvant MAID chemotherapy with poor response. She then underwent a second resection at an outside institution. Five months later, she was treated with radiation therapy to the base of the skull with no response. She expired from the disease 13 months after the diagnosis of the recurrence. CONCLUSION The prognosis for patients who recur is dismal. The treatment options are limited. Surgical management should be considered as uterine LMS has a low response to chemotherapy and surgical resection of LMS to sites such as lung and abdomen has been suggested to offer a benefit. Radiation therapy may provide palliative benefit in the setting of metastatic disease.
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Affiliation(s)
- Julie Sandruck
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Prentice Women's Hospital, Northwestern University, Chicago, IL 60611, USA
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Paulino AC, Nguyen TX, Barker JL. Brain metastasis in children with sarcoma, neuroblastoma, and Wilms' tumor. Int J Radiat Oncol Biol Phys 2003; 57:177-83. [PMID: 12909231 DOI: 10.1016/s0360-3016(03)00502-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the incidence and prognosis of children who develop brain metastasis. MATERIALS AND METHODS The medical and tumor registry records of 611 children treated at the University of Iowa Hospitals and Clinics between 1965 and 2000 for a sarcoma, neuroblastoma, or Wilms' tumor were reviewed. RESULTS Thirty children (4.9%) were found to have brain metastasis. Brain metastasis occurred in 9 of 113 (8%) neuroblastoma, 7 of 104 (6.7%) rhabdomyosarcoma, 6 of 105 (5.7%) Ewing's sarcoma, 5 of 106 (4.7%) osteosarcoma, 2 of 83 (2.4%) nonrhabdomyosarcoma soft-tissue sarcoma, and 1 of 100 (1%) Wilms' tumor patients. There were 22 male and 8 female patients, with a median age of 14 years at the time of diagnosis of brain metastasis (range 8 months-20 years). Four patients were diagnosed at autopsy, whereas five had brain metastasis at initial diagnosis. For the 25 children who did not have brain metastasis at initial presentation, the median interval from initial diagnosis to development of brain metastasis was 5 months (range 1-43 months). Twenty-nine (97%) had concurrent or prior history of distant metastasis. Eighteen (60%) had solitary brain metastasis. Treatment for the 26 non-autopsy-diagnosed children included surgery (S), followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 2, S and postoperative RT in 1, RT and CT in 16, S alone in 2, CT alone in 2, RT alone in 1, and no treatment in 2. Median survival was 4 months after diagnosis of brain metastasis, with a 1-year survival rate of 11.5%. On multivariate analysis, only the use of RT was found to positively influence freedom from neurologic progression (p = 0.005). CONCLUSION Brain metastasis is uncommon in children with a diagnosis of sarcoma, neuroblastoma, or Wilms' tumor and is often accompanied by concurrent distant disease. Children treated with RT for brain metastasis had a better freedom from neurologic progression rate than those who did not receive radiotherapy.
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Affiliation(s)
- Arnold C Paulino
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA.
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Reichardt P, Lindner T, Pink D, Thuss-Patience PC, Kretzschmar A, Dörken B. Chemotherapy in alveolar soft part sarcomas. What do we know? Eur J Cancer 2003; 39:1511-6. [PMID: 12855256 DOI: 10.1016/s0959-8049(03)00264-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Alveolar soft part sarcoma (ASPS) is a rare tumour. Published series about treatment and outcome are scarce. Conclusive data about the response to chemotherapy are not available. The aim of this study was to analyse the efficacy of palliative chemotherapeutic treatment options and the incidence and mode of presentation of brain metastases. We retrospectively analysed our own sarcoma data-base and reviewed the literature. From our registry containing 757 patients, we identified 8 patients with ASPS. From the literature, 47 cases of adult patients and 13 children with sufficient data about chemotherapy were identified. Response to first-line chemotherapy in 68 patients was: complete remission (CR) 4%, partial remission (PR) 3%, stable disease (SD) 41%, progressive disease (PD) 51%. 285 patients with stage IV disease were evaluable for the analysis of metastatic sites. The incidence of brain metastases was 30.5% (87/285). Brain metastases were detected at a median interval of 48 months (range 0-396 months) after the primary diagnosis. Median survival after the diagnosis of brain metastases was 12 months. The median survival for patients with stage IV disease treated by chemotherapy was 36+ months (range 10-132 months) (31 patients evaluable) with a median follow-up of 46 months (range 10-135 months). ASPS shows a high incidence of brain metastases, at least 3 times higher than that of other soft tissue sarcomas. Chemotherapeutic regimens used for the treatment of other soft tissue sarcomas lack efficacy in ASPS. Staging investigations for ASPS should routinely include imaging of the brain. ASPS patients should not be treated with chemotherapy outside of controlled clinical trials. New targets for specific biologically-directed therapies need to be developed.
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Affiliation(s)
- P Reichardt
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Robert-Rössle-Klinik, Helios-Klinikum Berlin, Universitätsklinikum Charité, Humboldt-Universität zu Berlin, Berlin, Germany.
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Brown PD, Brown CA, Pollock BE, Gorman DA, Foote RL. Stereotactic Radiosurgery for Patients with “Radioresistant” Brain Metastases. Neurosurgery 2002. [DOI: 10.1227/00006123-200209000-00009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Our aim was to evaluate the efficacy of stereotactic radiosurgery (SRS) for the treatment of patients with brain metastases that have been determined to be “radioresistant” on the basis of histological examination.
METHODS
We reviewed the medical records of 41 consecutive patients who presented with 83 brain metastases from radioresistant primaries and subsequently underwent SRS. All patients were followed until death or for a median of 31 months after SRS. Tumor histologies included renal cell carcinoma (16 patients), melanoma (23 patients), and sarcoma (2 patients). Eighteen patients (44%) had a solitary metastasis, and 23 patients (56%) had multiple metastases.
RESULTS
The median overall survival time was 14.2 months after SRS. On the basis of univariate analysis, systemic disease status (P = 0.006) and Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class (P = 0.005) were associated with survival. The median survival time was 23.5 months for patients in RPA Class I status and 10.5 months for patients in RPA Class II or III status. There was a trend (P = 0.12) toward improved median survival for patients with renal cell carcinoma (17.8 mo) as compared with patients with melanoma (9.7 mo). Multivariate analysis showed RPA class (P = 0.038) and histological diagnosis of primary tumor (P < 0.001) to be independent predictors for overall survival. In the 35 patients who underwent follow-up imaging, 9 (12%) of 73 tumors recurred locally. In 54% of the patients, distant brain failure (DBF) developed. Whole brain radiotherapy (WBRT) improved local control and decreased DBF, according to the univariate and multivariate analyses. Patients who received adjuvant WBRT in addition to SRS had 6-month actuarial local control of 100% as compared with 85% among those who did not receive WBRT (P = 0.018). Patients who received adjuvant WBRT with SRS had a 6-month actuarial DBF rate of 17%, as compared with a rate of 64% among patients who had SRS alone (P = 0.0027).
CONCLUSION
Well-selected patients with brain metastases from radioresistant primary tumors who undergo SRS survive longer than historical controls. RPA Class I status and primary renal cell carcinoma predict longer survival. Adjuvant WBRT improves local control and decreases DBF but does not affect overall survival. Further studies are needed to determine which patients should receive WBRT.
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Affiliation(s)
- Paul D. Brown
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Cerise A. Brown
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bruce E. Pollock
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Robert L. Foote
- Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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Espat NJ, Bilsky M, Lewis JJ, Leung D, Brennan MF. Soft tissue sarcoma brain metastases. Prevalence in a cohort of 3829 patients. Cancer 2002; 94:2706-11. [PMID: 12173340 DOI: 10.1002/cncr.10554] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Brain metastases from soft tissue sarcoma (STS) are uncommon. To the authors' knowledge limited information is available regarding the influence of the initial STS site, the significance of parenchymal versus leptomeningeal metastases, and the role of surgical resection. METHODS STS patients evaluated between July 1982 and March 1999 who presented with or developed brain metastases were identified from a prospective database. Association between factors was determined using the Fisher exact test. Survival was estimated using the Kaplan-Meier method. The influence of factors on the endpoint (disease specific survival [DSS]) was analyzed using the log-rank test. Significance was defined at P < or = 0.05. RESULTS A total of 3829 STS patients were evaluated during the study interval; 21 patients presented with and 19 patients subsequently developed brain metastases, accounting for < 1% (40 of 3829 patients) of the total patient group. The STS presentation status for this group of patients (n = 40) included 15 patients with primary STS, 1 patient with local recurrence, and 24 patients with metastatic disease. The most frequent types of STS metastasizing to the brain were leiomyosarcoma (eight patients), liposarcoma (five patients), rhabdomyosarcoma (four patients), and malignant fibrous histiocytoma (MFH) (four patients). Fourteen other sarcoma types were determined in the remaining 19 patients. Of the 19 patients who developed subsequent brain metastases, 18 had lung metastases as the immediate prior site of disease. The median overall follow-up for the 40 patients was 14 months (range, 1-128 months); for survivors (n = 5), the median overall follow-up was 18 months. During follow-up, 34 patients died of disease and 1 patient died of other causes. Brain metastasectomy was performed in 27 of the 40 patients and was highly associated with the initial site of STS; 20 of the 27 patients who underwent resection versus 2 of the 13 patients who did not undergo resection initially had extremity or trunk STS (P < 0.001). No association was observed between parenchymal versus leptomeningeal site of metastases and any outcome factor. The 1-year and 2-year overall DSS for the 40 patients was 55% and 25%, respectively, with a median survival of 15 months. The 1-year and 2-year postmetastasis survival rates were 34% and 20%, respectively, with a median survival of 7 months. Metastasectomy (n = 27) was associated with an improved median postmetastasis survival (9.6 months vs. 2.7 months for unresected patients; P < 0.01). The 2-year postmetastasis survival was 27% for those patients who underwent resection and 0% for the unresected patients. CONCLUSIONS Although brain metastases from STS are rare, vigilance is warranted. Symptomatic patients should be examined neurologically and investigated thoroughly for metastases. Surgical resection may be an appropriate treatment for selected patients; however, survival is dismal.
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Affiliation(s)
- N Joseph Espat
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Yoshida S, Morii K, Watanabe M, Saito T. Brain metastasis in patients with sarcoma: an analysis of histological subtypes, clinical characteristics, and outcomes. SURGICAL NEUROLOGY 2000; 54:160-4. [PMID: 11077098 DOI: 10.1016/s0090-3019(00)00293-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The clinical characteristics of brain metastasis from sarcoma are not well known. We examined the incidence and the characteristics of brain metastasis in patients with sarcomas. METHODS All sarcoma patients treated at our institution from 1975 to 1998 were reviewed for brain metastasis. Diagnosis of the primary tumor was confirmed histologically, and brain metastasis was confirmed using computed tomographic (CT) brain scan. RESULTS Brain metastasis was found in 27 (5.6%) of 480 patients with systemic sarcoma (7.2% soft part sarcoma, 3.5% bone sarcoma, 15.1% distant metastasis). Of these 27 sarcoma patients with brain metastases, lung metastasis occurred in 16 patients (59.3%). Out of 10 patients surgically treated, 8 patients survived more than 16 months. Median survival period after craniotomy was 25.4 months. CONCLUSIONS We recommend aggressive treatment for those patients with brain metastases whose performance scores are over 70.
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Affiliation(s)
- S Yoshida
- Department of Neurosurgery, Niigata Cancer Center Hospital, Niigata, Japan
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Wroński M, Arbit E. Surgical treatment of brain metastases from melanoma: a retrospective study of 91 patients. J Neurosurg 2000; 93:9-18. [PMID: 10883899 DOI: 10.3171/jns.2000.93.1.0009] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Reports on the surgical treatment of brain metastases from melanoma in a large group of patients are sparse. The goal of this paper is to review the surgical experience in a series of 91 patients with brain metastases from primary melanoma treated at a single institution. METHODS Seven hundred eighty patients underwent resection of brain metastases at Memorial Sloan-Kettering Cancer Center between 1974 and 1994. The records of 91 (11.7%) of these patients who had melanoma were retrospectively reviewed. The median time from diagnosis of the primary melanoma to diagnosis of the brain lesion was 14.1 months. The overall median length of survival following craniotomy was 6.7 months. Fifteen patients with resected multiple metastases had shorter median survival times than 76 patients with a single lesion (5.4 months compared with 7.8 months, p = 0.12). In eight patients with cerebellar metastases the median length of survival was significantly shorter than that found in patients with supratentorial lesions (2 compared with 7 months, p = 0.03). There was no difference in length of survival between 49 patients who underwent postoperative whole-brain radiation therapy (WBRT) and 29 patients who did not (9.5 compared with 8.3 months, p = 0.67). The incidence of brain metastasis recurrences in WBRT-treated and untreated patients was similar (56% and 45.7%, respectively). Only the presence of infratentorial metastases (p = 0.0013) and unresected recurrence of brain metastases (p = 0.0003) had an impact on outcome according to a Cox regression analysis. Five patients (5.5%) died within 31 days of surgery. Overall survival rates at 1, 2, 3, and 5 years were 36.3, 18.7, 13.2, and 6.6%, respectively. CONCLUSIONS Although melanoma metastatic to the brain carries a foreboding prognosis, patients who do not display preoperative neurological deficits, harbor a single lesion situated supratentorially, and have no lung or visceral metastases may derive significant palliative benefit from surgical resection of brain metastases.
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Affiliation(s)
- M Wroński
- Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10305, USA.
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Ogose A, Morita T, Hotta T, Kobayashi H, Otsuka H, Hirata Y, Yoshida S. Brain metastases in musculoskeletal sarcomas. Jpn J Clin Oncol 1999; 29:245-7. [PMID: 10379335 DOI: 10.1093/jjco/29.5.245] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In musculoskeletal sarcomas, brain metastases are rare, but severely affect quality of life. METHODS All patients with musculoskeletal sarcomas who were treated at our institutions from 1975 to 1997 were reviewed for examples of brain metastasis. RESULTS Of 480 sarcoma patients, 179 had distant metastases, including 20 patients with brain metastases (4.2%). Alveolar soft part sarcoma (3/4), extraskeletal Ewing's sarcoma (2/8), rhabdomyosarcoma (2/13) and bone Ewing's sarcoma (2/18) tended to metastasize to the brain. All 20 patients had distant or local relapses and 16 of the 20 patients had pulmonary metastases. Three patients underwent surgical treatment and two of them survived over 1 year. Mean survival after diagnosis of brain metastasis was 5.1 months. CONCLUSIONS Patients with alveolar soft part sarcoma, Ewing's sarcoma, rhabdomyosarcoma and pulmonary metastases have a high risk of brain metastasis.
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Affiliation(s)
- A Ogose
- Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Japan
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Abstract
BACKGROUND At the time of diagnosis of colorectal carcinoma, 2-3% of patients are likely to be harboring brain metastases, and another 10% of patients will develop brain lesions during the course of their disease. The purpose of this study was to examine the clinical course of a group of patients with metastatic brain disease who underwent surgical resection in a single institution. The authors believe this information will be useful for establishing prognostic factors and for clinical decision making. METHODS Between 1974 and 1993, 709 consecutive patients underwent surgical resection of brain metastases at Memorial Sloan-Kettering Cancer Center. Seventy-three patients had histologically confirmed colorectal carcinoma. The medical records of these patients were reviewed retrospectively, and the data were analyzed by univariate and multivariate analysis. RESULTS The median age of the 43 women and 30 men was 61.5 years. The median interval from the time of diagnosis of the primary tumor and the development of brain metastases was 27.6 months. The primary colorectal tumor was resected in all patients, and the median survival from the day of surgery was 38 months. The median survival from the time of craniotomy was 8.3 months. The 1-year and 2-year survival rates were 31.5% and 6.8%, respectively. Postoperative mortality was 4%. Gender, presence of multiple metastases, presence of lung lesions, and adjuvant brain radiation after craniotomy appeared to have no impact on survival as determined by multivariate Cox analysis. Only the presence of cerebellar brain metastases was associated with decreased survival. CONCLUSIONS The results of this series, which the authors believe is the largest series of resected brain metastases from colorectal carcinoma published to date, indicate that surgical resection may increase the survival of these patients. Analysis of prognostic factors shows that infratentorial tumor location is associated with a poorer survival compared with supratentorial tumor location (5.1 months vs. 9.1 months; P < 0.002). In patients with recurrent brain disease, repeated resection is a worthwhile consideration because it may prolong survival compared with patients who do not undergo re-resection.
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Affiliation(s)
- M Wroński
- Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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