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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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Mohammadi A, Mohammadi M, Pazoki M, Ayoubpour MR, Babaheidarian P, Zeraatian Nejad Davani S, Ghaderi R. Clinical presentation, diagnostic evaluation, and management of undifferentiated/unclassified cardiac sarcoma: A case report and literature review. Radiol Case Rep 2024; 19:1200-1207. [PMID: 38259715 PMCID: PMC10801150 DOI: 10.1016/j.radcr.2023.11.065] [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: 10/22/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024] Open
Abstract
This case report details a challenging instance of undifferentiated/unclassified cardiac sarcoma in a 28-year-old female, presenting with diverse symptoms like muscle weakness, shortness of breath, and hemoptysis. Diagnostic hurdles led to an initial misdiagnosis of granulomatosis with polyangiitis before discovering a sizable left atrial mass, ultimately diagnosed as high-grade undifferentiated/unclassified sarcoma. Despite initial surgical intervention, the patient's condition worsened, underscoring the complexities in managing such cases involving cardiac sarcomas. This case emphasizes the diagnostic complexities associated with primary cardiac sarcomas, particularly the challenges in achieving accurate diagnoses and formulating effective treatment strategies.
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Affiliation(s)
- Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahboubeh Pazoki
- Department of Cardiology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Mohammad reza Ayoubpour
- Department of Radiology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Pegah Babaheidarian
- Department of Pathology, School of Medicine, Hazrat-e Rasool General Hospital Iran University of medical sciences, Tehran, Iran
| | - Sam Zeraatian Nejad Davani
- Department of Cardiovascular Surgery, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ghaderi
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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4
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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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Smith DE, Hamby T, Heym K, Mohamed A, Vallance KL, Ray A. Intracranial Relapse in Pediatric Sarcoma. J Pediatr Hematol Oncol 2023; 45:e810-e816. [PMID: 37526369 DOI: 10.1097/mph.0000000000002713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/08/2023] [Indexed: 08/02/2023]
Abstract
Advances in local control techniques, chemotherapy regimens, and imaging modalities have led to improvements in both morbidity and mortality in pediatric sarcoma patients. However, approximately one-third of patients develop disease relapse and intracranial metastasis was considered rare. The incidence of sarcoma brain metastasis is thought to have increased and is associated with grim outcomes. This was a retrospective study of 3 deidentified patient charts illustrating the possibility of the central nervous system as a potential site for pediatric sarcoma relapse and investigate the patterns of such relapses. We note this is the first report of infantile fibrosarcoma brain metastasis and a rare report of sarcoma lymph node metastasis. In addition, each patient was treated with targeted therapies, including entrectinib, Ruxolitnib, and pazopanib. Caregivers in cases 2 and 3 reported new-onset neurological manifestations before identification of new brain metastasis, indicating a lag in detection of new intracranial relapse in asymptomatic sarcoma patients. We suggest implementing a brief review of systems screening tool focused on concerning neurological manifestations to screen for new brain metastasis.
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Affiliation(s)
- Danielle E Smith
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | - Tyler Hamby
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
- Departments of Research Operations
| | - Kenneth Heym
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Ashraf Mohamed
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Kelly L Vallance
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
| | - Anish Ray
- Pediatric Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX
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6
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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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7
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Ababneh HS, Muhsen B, Fares AS, Hirbawi H, Awabdeh TA, Hussaini MA, Amarin R, Mousa AA, Salah S. Sarcoma brain metastases: Tertiary cancer center experience. J Cancer Res Ther 2023; 19:S758-S763. [PMID: 38384052 DOI: 10.4103/jcrt.jcrt_654_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Brain metastasis (BM) from bone and soft tissue sarcomas (STS) is very rare and mostly predicts dismal prognosis. Owing to its' rarity, data on optimal therapy including surgical management, chemotherapy, and radiotherapy is scarce. We sought to assess the prevalence, disease characteristics, and outcomes of BM in bone and STS patients treated at a single institution. METHODS A retrospective chart review was performed for consecutive bone and STS patients treated at King Hussein Cancer Center from 2007 to 2020. Patients with BM were identified. Survival was estimated by the Kaplan-Meier method. Factors of possible effect on OS was examined in univariate analysis. Survival comparisons were carried out by the log-rank test. RESULTS A total of 1,548 bone and STS patients were treated at our center during the eligibility period. We identified 18 patients (1.1%) who had BM at initial presentation (n = 16, 1.0%) or during follow up (n = 2; 0.1%). Fourteen patients (77.8%) were male. The median age was 29.5 years (range: 0.1-60 years). The primary tumor was most commonly located in the extremities (61%). Ten different histopathological subtypes were encountered; Ewing sarcoma (ES) was the most common (n = 4; 28%). Twelve patients (67%) had lung metastasis as the first site of metastatic disease. BM was detected at a median time of 12 months following sarcoma diagnosis (range: 1-71 months). A total of 10 patients (56%) had solitary metastasis and 4 patients (22.2%) had hemorrhagic metastasis. The most common location of brain metastatic lesions was the occipital lobe (n = 4; 22.2%). Thirteen patients received treatment for metastatic brain sarcoma. The most common treatment modality was radiotherapy, received by a total of 10 patients (55.5%), followed by surgical intervention performed in a total of 5 patients (27.7%), The other treatment modalities included combined chemo-radiotherapy (n = 2), targeted therapy plus chemotherapy, and targeted therapy plus radiotherapy (n = 1, each). At a median follow up of 10 months following detection of BM, the median OS was 4.0 months; (95% CI: 2.54-5.46). We did not identify any factor that influenced OS in univariate analysis. CONCLUSION Sarcoma BM is exceedingly rare and herald's dismal prognosis. ES was a major histological subtype accounting for BM metastasis in our series.
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Affiliation(s)
- Hazim Sameer Ababneh
- Division of Neurosurgery, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Baha'eddin Muhsen
- Division of Neurosurgery, Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Salah Fares
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Tala Al Awabdeh
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Rula Amarin
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Abdlatif Al Mousa
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Samer Salah
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan
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Manizhe AK, Mohseni I, Sahranavard A, Tabrizi Z. Recurrent primary intracranial synovial sarcoma, a case report and review of the literature. Clin Case Rep 2022; 10:e6273. [PMID: 36093454 PMCID: PMC9445261 DOI: 10.1002/ccr3.6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 11/23/2022] Open
Abstract
Synovial sarcoma (SS) occurs in various parts of the body, predominantly in the extremities. It also occurs in organs without synovial structures. The intracranial disease has been reported as metastasis, but primary intracranial SS has been reported rarely. We report a patient with hemiplegia and a mass on the brain CT. Pathology showed SS with no extracranial pathology. Synovial sarcoma (SS) is one of the most common sarcomas of soft tissue, and it mostly occurs in the lower extremities. It can cause metastasic disease, especially in the lungs, bones, and lymph nodes. Metastasis in the brain is very rare. Primary intracranial SS has also been reported in extremely rare cases. In this article, we study the case of a 28‐year‐old man with primary intracranial SS.
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Affiliation(s)
- Ataee Kachuee Manizhe
- Department of Radiology, Firouzgar Hospital Iran university of medical science Tehran Iran
| | - Iman Mohseni
- Department of Radiology, Firouzgar Hospital Iran university of medical science Tehran Iran
| | - Alireza Sahranavard
- Department of orthopaedics surgery, Alzahra hospital Isfahan university of medical science Isfahan Iran
| | - Zhale Tabrizi
- Department of Radiology Iran university of medical science Tehran Iran
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9
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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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10
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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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11
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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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Outcomes and the Role of Primary Histology Following LINAC-based Stereotactic Radiation for Sarcoma Brain Metastases. Am J Clin Oncol 2020; 43:356-361. [PMID: 32217854 DOI: 10.1097/coc.0000000000000675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The brain is a rare site for sarcoma metastases. Sarcoma's radioresistance also makes standard whole-brain radiotherapy less appealing. We hypothesize that stereotactic radiation techniques (stereotactic radiosurgery [SRS]/stereotactic fractionated radiotherapy [FSRT]) may provide effective local control. MATERIALS AND METHODS This single-institution retrospective analysis evaluated our experience with linear acceleator-based SRS/FSRT for sarcoma brain metastases. Time to event analysis was estimated via Kaplan-Meier. Univariable/multivariable Cox regression analyses followed to assess the impact of patient and disease characteristics on outcomes. RESULTS Between 2003 and 2018, 24 patients were treated with 34 courses of SRS/FSRT to 58 discrete lesions. The median age at first treatment was 57 years (range: 25 to 87 y). Majority of patients had concurrent lung metastases (n=21; 88%), diagnosed spindle cell sarcoma (n=15; 25%) or leiomyosarcoma (n=12; 21%) histology, and were treated with either SRS (n=43; median dose=19 Gy, range: 15 to 24 Gy) or FSRT (n=17; 3/5 fractions, median dose=25 Gy, range: 25 to 35 Gy). With a median follow-up after brain metastasis of 7.3 months, the 6 month/12 month local control, distant brain control, and overall survival of 89%/89%, 59%/34%, and 50%/38%, respectively. All local failures were of primary spindle cell histology (P<0.001), which was associated with poorer distant control (hazard ratio=25.8, 95% confidence interval: 3.1-536.4; P=0.003) on univariable analysis, and OS (hazard ratio=7.1, 95% confidence interval: 2.0-26.1; P=0.003) on multivariable analysis. CONCLUSIONS This is the largest patient cohort with sarcoma brain metastases treated with SRS/FSRT, it provides durable local control, despite a reputation for radioresistance. Further prospective evidence is required to determine the impact of primary histology on control and survival following brain metastasis diagnosis.
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Abstract
Introduction: Primary cardiac tumors are exceedingly rare, with approximately 75% representing benign lesions. Sarcoma represents the most common primary cardiac malignancy, with a wide range of sarcoma histologies represented. Symptoms at diagnosis vary based on tumor location. Multidisciplinary treatment including chemotherapy, surgery, and occasionally radiation is often warranted. Despite aggressive treatment, the overall prognosis for primary cardiac sarcoma (PCS) remains poor with a median survival of approximately 1 year.Areas covered: A PubMed search for the key terms; 'cardiac sarcoma', 'primary cardiac sarcoma', and 'treatment' were conducted. Abstracts were reviewed for reports on presentation, treatments, and outcomes in PCS. Available data was limited to single-institution series, most of which were retrospective. Patterns of symptoms at diagnosis varied with tumor location (right vs. left vs. pericardium). Multimodality therapy, including chemotherapy and surgical resection was most commonly reported. Completely negative margin (R0) resection has the greatest impact on overall survival.Expert opinion: Given the rarity of PCS, patients should be referred to a high-volume sarcoma center for multidisciplinary evaluation. Neoadjuvant chemotherapy should be considered to aid in surgical resection. Due to the propensity for brain metastases in cardiac tumors, brain MRI at the time of diagnosis should be considered.
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Affiliation(s)
| | - Monika Leja
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rashmi Chugh
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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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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Melone GA, D'Elia A, Brogna C, Salvati M. Uterine Leiomyosarcoma Metastatic to the Brain: Case Report. TUMORI JOURNAL 2018; 94:856-60. [DOI: 10.1177/030089160809400615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background We report a leiomyosarcoma of the uterus, an uncommon tumor with a very aggressive course and poor prognosis due to the fact that, despite complete resection, it recurs with micrometastases. The most common metastatic sites are the lung, intraperitoneal, pelvic and paraaortic lymph nodes, and liver. Brain and skull metastases are very rare. Case A 57-year-old woman underwent a hysterectomy and bilateral salpingo-oophorectomy for a grade T2N0M0 uterine leiomyosarcoma. There was no evidence of other lesions. Three months later a total-body PET scan demonstrated the presence of metastases in both lungs, and the patient was started on chemotherapy. One year later a cranial MRI demonstrated a brain metastasis to the temporal lobe. Emergency complete resection of the recurrence was performed, followed by whole-brain radiation and adjuvant chemotherapy. Conclusions Given the limited treatment options, the gold standard for uterine leiomyosarcoma brain metastasis is total surgical removal. Chemotherapy and radiation therapy may provide only palliative benefit.
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Affiliation(s)
- Graziella Angelina Melone
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Alessandro D'Elia
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Christian Brogna
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Maurizio Salvati
- Department of Neurosurgery-INM Neuromed IRCCS, Pozzilli (Is), Italy
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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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Primary Intracranial Synovial Sarcoma. Case Rep Neurol Med 2016; 2016:5608315. [PMID: 27247811 PMCID: PMC4876212 DOI: 10.1155/2016/5608315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression.
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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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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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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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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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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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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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24
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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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25
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Abbassi R, Kacemi L, Jroundi L, Chami I, Boujida N. [Brain metastases as the presenting feature of soft tissue sarcoma: report of two cases]. JOURNAL DE RADIOLOGIE 2008; 89:514-516. [PMID: 18477960 DOI: 10.1016/s0221-0363(08)71457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- R Abbassi
- Service de Radiologie, Institut National d'Oncologie, Rabat, Morocco.
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Matsumine A, Kusuzaki K, Hirata H, Fukutome K, Maeda M, Uchida A. Intraneural metastasis of a synovial sarcoma to a peripheral nerve. ACTA ACUST UNITED AC 2005; 87:1553-5. [PMID: 16260679 DOI: 10.1302/0301-620x.87b11.16522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of intraneural metastasis of a synovial sarcoma, the first published case of a metastasis of a soft-tissue sarcoma to a peripheral nerve.
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Affiliation(s)
- A Matsumine
- Department of Orthopaedic Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu-city, Mie 514-8507, Japan.
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