Clinical Outcome of the Patients With Brain Metastasis from Soft Tissue Sarcomas

Abstract

Background/Aim: This study aimed to evaluate the association of clinical characteristics with treatment outcomes to ascertain the appropriate treatment options for soft tissue sarcomas (STS) patients with brain metastasis (BM). Patients and Methods: Medical records of STS patients with BM who were treated in our institutions were retrospectively reviewed, and analyzed to identify the factors associated with post-BM survival. Results: Among the 509 STS patients, BM occurred in five patients (0.98%). The median survival after BM was 1.5 months. Histological subtypes of the primary lesions in the five BM patients were: two synovial sarcomas, one myxoid liposarcoma, one alveolar soft part sarcoma, and one rhabdomyosarcoma. Among the five BM patients, the post-BM survival of two patients, who underwent surgery and postoperative radiotherapy, was longer than that of the other patients (p<0.01). Conclusion: Combined surgery and postoperative radiotherapy effectively managed symptoms and prolonged survival in STS patients with BM.Soft tissue sarcomas (STS) are uncommon and heterogeneous cancers of mesenchymal origin, representing approximately 1% of cancers in the adult population (1). Although adequate wide resection is the dominant curative therapy for primary STS (2), a multidisciplinary approach using chemotherapy and/or radiotherapy should be considered as pre-or post-operative adjuvant therapies (3). Half of patients with high-grade STS have been reported to die from metastatic disease, which may present as microscopic foci at the time of primary diagnosis (4). This is especially true in the lung, which is the most common site of distant metastasis (5). Brain metastasis (BM) in STS is rarely encountered, with a reported incidence of 1-8% (6-14). However, its incidence has been increasing due to advances in chemotherapeutic agents and diagnostic imaging technology (15). BM significantly affects the quality of life (QOL) and the prognosis of the patients. The mean overall survival after BM has been reported to be 1.8 to 11.8 months (6,7,9,(11)(12)(13)(15)(16)(17)(18). Therefore, early diagnosis and effective treatment are crucial for BM patients. Valid treatment options for BM are surgery, radiotherapy, chemotherapy, and their combination. Previous reports have demonstrated that surgery and postoperative radiotherapy prolonged survival after BM, and it may be widely accepted as a standard treatment approach for BM from STS (19,20). However, the appropriate treatment for each patient is still controversial due to the limited information available.In the present study, we retrospectively reviewed BM in STS patients to clarify the prognostic factors that may affect post-BM survival in patients. We focused on the appropriate treatment for each patient. Patients and MethodsEthical considerations. This study was approved by the Ethics Review Board of our institutions (#B190213). Informed consent was obtained in the form of an opt-out system. Those who rejected were excluded.

Neuroimaging Findings in Symptomatic Hypertensive Encephalopathy

“…Conditions to which cerebral microbleeds are associated include ageing, cerebral amyloid angiopathy (Fig 6), Alzheimer's Disease, cerebrovascular disease, chronic hypertensive encephalopathy ( Fig 7), diffuse axonal injury 92 , septic emboli 93 melanoma metastases 94 , multiple familiar cerebral cavernomas 95 , cardiothoracic surgery with extracorporeal circulation 96 and cerebral radiation therapy 97 ; much less frequently but still possible, metastasis from sarcomas may present acutely as macro or microbleeds 98,99 The most frequent cause of cerebral microbleeds with a non-lobar or mixed pattern in common practice tends to be HTN 100 , which also developed in animal models subject to a high salt diet 101 , being related to a higher incidence of spontaneous intra cerebral bleeds, worse outcomes in acute cerebrovascular disease and higher incidence of post thrombolysis bleeds 57 .…”

Radiation Therapy in Metastatic Soft Tissue Sarcoma: From Palliation to Ablation

“…Survival after development of brain metastasis is very poor with median survival of 1.5 months [ 39 ]. Survival was longer in patients who underwent local therapy with surgery and radiotherapy [ 42 , 43 ]. As such, local control of brain metastases is paramount to preserving function and potentially improving survival.…”

A retrospective analysis of the prognosis of Japanese patients with sarcoma brain metastasis

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 The incidence of BM was estimated to be 0.6%–3.2% among sarcoma patients according to previous literature. 3 , 4 , 6 , 12 , 15 In addition, the prognosis after BM is reportedly dismal. 1 , 2 , 3 , 5 , 7 , 12 , 14 …”

“… 3 , 4 , 6 , 12 , 15 In addition, the prognosis after BM is reportedly dismal. 1 , 2 , 3 , 5 , 7 , 12 , 14 …”