THE TREATMENT AND OUTCOME OF PATIENTS WITH SOFT TISSUE SARCOMAS AND SYNCHRONOUS METASTASES

Kane JM, Gibbs JF, Kraybill WG (Roswell Park Cancer Institute, Buffalo, NY 14263)

Background: Soft tissue sarcomas (STS) account for approximately 1% of all adult tumors in the United States. Although significant advances have been made in the control of the primary tumor, the development of metastases remains a major determinant of mortality from STS. Factors predictive of poor survival with metastatic disease include large tumor size, age > 50 years, unresectable metastases, and a short disease free interval. Therefore, soft tissue sarcoma patients who present with synchronous metastases would appear to have a dismal prognosis. The purpose of this study was to examine a cohort of patients with STS and synchronous metastases to better define the variables that impact on their survival.

Methods: Forty-eight patients were identified from the Roswell Park Cancer Institute Tumor Registry with STS and synchronous metastases. Information was collected in regard to patient demographics, presentation, tumor characteristics, treatment, follow-up, and survival.

Results: Overall, the patients had a relatively short interval from symptoms to diagnosis (median time 3.1 months). As expected, a significant proportion of the patients were older and had large, high grade tumors. Leiomyosarcoma was the most frequent histology at 23%. The most common site of metastatic disease was the lungs (63% of all patients). Ninety-four percent of patients had surgery at the site of the primary tumor and local control was achieved in 54%. Thirty-five percent of patients underwent at least one attempted metastasectomy. Chemotherapy was administered to the majority of patients and 31% were treated with three or more different regimens. Twenty-five percent of patients were given at least one regimen of chemotherapy via a non-intravenous route (intraarterial, intraperitoneal, or intrathoracic). Median overall survival for the entire group was 15 months with a two and five year survival of 21% and 5%, respectively. Three or more regimens of chemotherapy and a non-intravenous route were the only factors that significantly impacted upon an overall survival of greater than twelve months.

Conclusion: Despite the lack of a disease free interval, the overall survival of patients with STS and synchronous metastases is comparable to that reported in the literature for patients who develop delayed metastatic disease. Unfortunately, there are no specific variables to predict which patients will enjoy prolonged survival. Therefore, patients with STS and synchronous metastases should be treated aggressively with chemotherapy, surgical resection, and selective metastasectomy despite the presence of concurrent metastatic disease.