Brain Metastases in Patients With Soft-Tissue Sarcomas: Management and Survival—A SEER Population-Based Cohort Study

Abstract

Introduction: Brain metastases (BM) in soft-tissue sarcomas (STS) is associated with poor prognosis. This large population analysis presents (1) demographic and clinical variables of these patients, (2) potential risk factors, (3) impact of BM on overall survival, and (4) treatment strategies. Methods: Patients with STS and BM were identified from the Surveillance, Epidemiology, and End Results database. Demographic and clinical variables, as well as treatment modalities, were analyzed. Overall 5-year survival was calculated using the Kaplan-Meier method, and the survival difference was assessed using the log-rank test. A multivariate analysis was performed using the Cox proportional hazard regression to determine the risk factors. Results: Twenty-two patients (22/8,433) with STS presented BM at diagnosis. A multivariate analysis showed that women and American Indians/Alaska Natives had a greater risk of presenting BM. The most common histological subtype to metastasize to the brain was alveolar soft part sarcoma (4/22). In 54.5% of patients with BM, the tumor had also metastasized to the lung, although having synchronous bone, liver, and lung metastases showed the greatest increase in risk for presenting BM (odd ratio [OR] = 1,857.7, confidence interval [CI] 95%, 88.4 to 3,9046.6, P < 0.0001). Individually, bone metastasis increased the risk of presenting BM the most (OR = 205.0, CI 95%, 30.5 to 1,379.6, P < 0.0001). The mean survival of patients with BM was 10.22 months. The standard treatment approach included surgery, radiation therapy, and chemotherapy. Conclusion: BM in patients with STS represents an infrequent but lethal event. Women and American Indians/Alaska Natives are at a higher risk of presenting BM, as well as patients with synchronous metastases. Patients are mainly managed with systemic therapy.

Brain metastasis from a thoracic myxofibrosarcoma: A case report and literature review

“…Intracranial MFS is rare and some reports have described cases without extracranial sites. [ 3 , 6 , 14 , 16 ] Sarrami et al . reported a case of MFS with infiltration of the pons, cerebellum, and basal surface of the left temporal lobe without any visible masses.…”

“…[ 14 ] Thirty-nine previously reported cases were related to location/origin in the brain, treatment, and follow-up, which showed a consensus regarding the diagnosis and treatment of the primary tumor. [ 6 ] Brain metastasis was associated with a higher risk when multiple metastases to bone, liver, and lung were reported by a population-based cohort study with 0.26% of the cases with brain metastasis of the 8.433 patients with STS. [ 6 ] Other risk factors for brain metastasis in STS were being female and American Indian/ Alaska Native.…”

“…[ 6 ] Brain metastasis was associated with a higher risk when multiple metastases to bone, liver, and lung were reported by a population-based cohort study with 0.26% of the cases with brain metastasis of the 8.433 patients with STS. [ 6 ] Other risk factors for brain metastasis in STS were being female and American Indian/ Alaska Native. [ 6 ]…”

“…[ 6 ] Other risk factors for brain metastasis in STS were being female and American Indian/ Alaska Native. [ 6 ]…”

“…Intracranial MFS is rare and some reports have described cases without extracranial sites. [3,6,14,16] Sarrami et al reported a case of MFS with infiltration of the pons, cerebellum, and basal surface of the left temporal lobe without any visible masses. [16] A 55-year-old man presented with MFS presenting as an acute cerebral hemorrhage, with subsequent development of lung metastases.…”