Multidisciplinary Management of Oligometastatic Soft Tissue Sarcoma

Abstract

Soft tissue sarcomas (STS) encompass a group of rare but heterogeneous diseases. Nevertheless, many patients, particularly those with oligometastatic disease can benefit from thoughtful multimodality evaluation and treatment regardless of the STS subtype. Here, we review surgical, interventional radiology, radiation, and chemotherapy approaches to maximize disease palliation and improve survival, including occasionally long-term disease-free survival. Surgical resection can include lung or other visceral, soft tissue and bone metastases with a goal of rendering the patient disease free. Staged resections can be appropriate, and serial resection of oligometastatic recurrent disease can be appropriate. Retrospective series suggest survival benefit from this approach, although selection bias may contribute. Interventional radiology techniques such as percutaneous thermal ablation (PTA) and arterial embolization can present nonoperative local approaches in patients who are not medically fit for surgery, surgery is too morbid, or patients who decline surgery. Similarly, radiation therapy can be delivered safely to areas that are inaccessible surgically or would result in excessive morbidity. Currently no randomized trials exist comparing interventional radiologic approaches or radiation therapy to surgery but retrospective reviews show relatively similar magnitude of benefit in terms of disease palliation and survival, although it is felt unlikely that these procedures will render a patient to long-term disease-free status. Chemotherapy has evolved recently with the addition of several new treatment options, briefly reviewed here. Importantly, if a patient sustains a good response to chemotherapy resulting in true oligometastatic disease, consideration of multimodality local therapy approaches can be considered in the appropriate patient.

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Analysis of the Chemotherapy-Free Interval following Image-Guided Ablation in Sarcoma Patients

“…Multiple studies have identified the benefits of ablation as a therapeutic option in the management of patients with sarcoma [12][13][14][15][16]. Ablation is minimally invasive, lacks treatment-specific toxicity, and provides a lower-morbidity treatment option compared to surgical resection [17,18]. For patients with metastatic sarcoma, while image-guided ablation may extend the chemotherapy-free interval, it remains unknown how long ablation could extend the chemotherapy-free interval.…”