Pulmonary metastasectomy from soft tissue sarcomas

Abstract

INTRODUCTION: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.METHODS: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.RESULTS: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.CONCLUSION: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.

Pulmonary metastasectomy and repeat metastasectomy for soft-tissue sarcoma

“…3 However, some other studies did not prove any association between the number of metastases and patient survival. 18 We found a relatively lower success rate and lower overall survival rate in patients with a higher number of metastases (>2 vs. 1-2), but the difference did not reach statistical significance. We did not find any significant correlation between the size of metastasis and survival, although some studies suggested that larger size of metastasis resulted in poorer outcomes.…”

Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data

“…There was one retrospective cohort study of data obtained from a Cancer Centre's institutional Tumor Registry 11. In other reports, cases were identified from databases which were held, as far as we could determine, at an institutional level10 12–17 20 23 26 27 or departmental level 18 19 21 24 25. It appears that many of the clinical data were retrieved by retrospective case note review.…”

“…In individual instances authors specified that there should be no mediastinal or chest wall involvement;17 absence of pericardial or pleural effusions;12 that the overall operative risk was acceptable;26 or that there was no other available more effective treatment 19. In one report, increased size on chemotherapy was allowable, but not an increase in the number of metastases 24.…”

“…Some authors stated that preoperative and/or postoperative chemotherapy was given routinely in all cases10 21 26 27 but more often the practice varied 11–14 16 18 21. One paper states “The only constant was that when the disease-free interval was <2 years with a single lung metastasis, no chemotherapy was added to surgery” and another that it was at the discretion of the oncologist 19. One group used chemotherapy preoperatively only when there were six or more metastases 17.…”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…Sardenberg et al (39) evaluated the treatment of patients with non-lung primary tumors. The authors concluded that pulmonary metastasectomy is a safe and potentially curative procedure for such patients, and that select patients can achieve long-term survival after lung resection.…”