Long-term results after resection for soft tissue sarcoma pulmonary metastases

Department of General Thoracic Surgery, Clinica Universidad Navarra, Avenida Pio XII 36, Pamplona 31008, Spain.
Interactive Cardiovascular and Thoracic Surgery (Impact Factor: 1.16). 06/2009; 9(2):223-6. DOI: 10.1510/icvts.2009.204818
Source: PubMed


Isolated pulmonary metastases from soft tissue sarcomas (STS) occur in approximately 20% of the cases. Chemotherapy and surgical resection are the current standard treatment options for these patients. Our goal was to identify any prognostic factors for these patients as well as to estimate their long-term survival rate. We examined a series of twenty-two consecutive patients with pulmonary metastases from STS, treated in our institution from 1996 to 2006. Univariate (log-rank and Cox-regression) analysis was performed to identify any significant prognostic factor. Five-year survival rates were estimated by using Kaplan-Meier methods. Four patients (18.2%) were alive without any disease, twelve patients (54.5%) died of disease and we lost all track of six patients (27.3%). Follow-up period ranged from 7 to 75 months. Median follow-up: 14 months, median survival: 19 months. Disease-free interval (DFI) (P=0.005), number of lung nodules (P=0.04) and histology type (P=0.01) were significant prognostic factors at univariate analysis. The overall five-year survival rate was 23.1%. DFI, number of lung nodules at surgery and metastatic histology are significant prognostic factors for patients with resected pulmonary metastases from STS.

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    • "Pulmonary metastasectomy (PM) for sarcomas is becoming a widely accepted practice, as several retrospective studies have suggested improvement in survival following PM and reported encouraging 5-year survival rates of 23–52% [1] [2] [3] [4] [5] [6] [7], which compares favourably with the poor survival for cohorts of patients treated with non-operative therapy [8] [9]. Nevertheless, the apparent favourable survival with PM over chemotherapy could be the result of positive selection of patients treated with PM and the result of including patients with unresectable metastases in the cohorts treated with non-operative therapy: a fact that leads some authors to question the benefit from surgery [10] [11] [12] [13]. "
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    ABSTRACT: OBJECTIVES Pulmonary metastasectomy for sarcoma is a widely accepted practice. Nevertheless, no previous studies has been reported the outcomes following metastasectomy compared with chemotherapy for patients with resectable and isolated pulmonary metastases. Our aim is to compare these modalities for the subset of patients with resectable metastases. Furthermore, the outcomes for patients with unresectable lung metastases are reported.METHODS Sarcoma patients with isolated lung metastases were identified and their computed axial tomography scans were reviewed by a thoracic surgeons' committee. Patients were divided into three groups: A: patients with resectable metastases treated with metastasectomy (n = 29), B: patients with resectable metastases who received systemic therapy (n = 17) and C: patients with unresectable metastases (n = 25). Survival outcomes were plotted and compared through log-rank test for osteosarcoma and non-osteosarcoma patients.RESULTSSeventy-one patients (32 with osteosarcoma and 39 with non-osteosarcoma) were eligible. Progression-free survival (PFS) was superior in patients who belonged to Group A compared with Groups B and C (8.0, 4.3 and 2.2 months, respectively, P = 0.0002). Furthermore, overall survival (OS) was superior in patients who belonged to Group A compared with Groups B and C (39.6, 20.0 and 7.8 months, respectively, P < 0.0001). A subanalysis for osteosarcoma patients showed superior PFS and OS for Group A vs B (median PFS 21.6 and 3.65 months, respectively, P = 0.011 and median OS 34.0 and 12.4 months, respectively, P = 0.0044). For non-osteosarcoma patients, there were no such significant survival differences between Groups A and B. Overall, patients who belonged to Group A had significantly lower mean percentage of their follow-up time spent admitted at hospital, and a trend towards lower requirements for home oxygen therapy.CONCLUSION Pulmonary metastasectomy is associated with improved survival of osteosarcoma patients with resectable lung metastases. For non-osteosarcoma patients, the survival benefit of metastasectomy over chemotherapy is uncertain and warrants further evaluation. Patients with unresectable metastases have poor prognosis.
    Interactive Cardiovascular and Thoracic Surgery 04/2013; DOI:10.1093/icvts/ivt177 · 1.16 Impact Factor
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    • "Complete resection was achieved in 62 patients (80.5%). This variable was a strong prognostic indicator in the multivariate analyses (p<0.001), which is consistent with previous reports.5-7,10,11,21,22 The median survival for patients who underwent complete resection was 44.8 months, as compared to 9.5 months in the group who underwent incomplete resection (n = 15). "
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    ABSTRACT: Isolated pulmonary metastases from soft tissue sarcomas occur in 20-50% of these(the issue is about metastases, not lung cancer )patients, and 70% of these patients will present disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated in the lungs, and many studies investigating this technique have reported an overall 5-year survival ranging from 30-40%. The most consistent predictor of survival in these patients is complete resection. The aim of the present study was to determine the demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. We performed a retrospective review of patients admitted in the Thoracic Surgery Department with lung metastases who underwent thoracotomy for resection following treatment of the primary tumor. Data regarding primary tumor features, demographics, treatment, and outcome were collected. One hundred twenty-two thoracotomies and 273 nodules were resected from 77 patients with previously treated soft tissue sarcomas. The median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the following independent prognostic factors for overall survival: the number of metastases resected, the disease-free interval, and the number of complete resections. These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection.
    Clinics (São Paulo, Brazil) 09/2010; 65(9):871-6. DOI:10.1590/S1807-59322010000900010 · 1.19 Impact Factor
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    ABSTRACT: BACKGROUND: Soft tissue sarcomas (STS) are a rare group of tumors with mesenchymal origin. They account for about 1% of all malignancies in adults. Due to the rareness of this tumor group, randomized clinical trials are scarce and there is little evidence concerning treatment options. METHODS: Clinical trials, published to date and literature were reviewed and edited. RESULTS: Possible different treatment approaches reflecting the present standard of care are presented and discussed. CONCLUSIONS: A multidisciplinary therapy approach and more randomized clinical trials are mandatory to improve the care for patients with STS. GRUNDLAGEN: Weichteilsarkome (WTS) sind eine Gruppe seltener Tumore mesenchymalen Ursprungs und bilden rund 1 % aller Neoplasien bei Erwachsenen. Aufgrund ihrer Seltenheit sind bisher nur sehr wenig randomisierte Studien durchgeführt worden und daher gibt es sehr wenig Evidenz für Behandlungsoptionen. METHODIK: Die klinischen Studien und gesamte rezente Literatur zu diesem Thema wurde gesichtet und aufgearbeitet. ERGEBNISSE: Verschiedene mögliche Behandlungsoptionen und Strategien, die den derzeitigen Therapiestandard reflektieren, werden präsentiert und diskutiert. SCHLUSSFOLGERUNGEN: Eine interdisziplinärer Therapieplanung und mehr randomisierte klinische Studien sind zur Verbesserung der Behandlung von Patienten mit WTS erforderlich.
    European Surgery 08/2009; 41(4):170-175. DOI:10.1007/s10353-009-0480-y · 0.27 Impact Factor
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