LONG-TERM SURVIVAL OF METASTATIC SOFT TISSUE SARCOMAS

Krarup-Hansen A^1,3, Fisher C², Al-Muderis O¹, Carter T¹, Judson I¹ (Sarcoma Unit¹, Dept. of Histopathology², Royal Marsden NHS Trust Hospital (RMH), Fulham Road, London SW3 6JJ, Dept. of Oncology³, National University Hospital, DK-2100 Copenhagen)

Introduction: Soft tissue sarcomas (STS) are rare tumors, accounting for ca.1% of all malignancies. 5-year (y) survival after primary excision is approx. 60% and falls to 30% if re-excision is required. Prognostic factors of STS are tumour size, grade, site, deep/superficial and presence of metastases. Long-term survival (LTS) (>4-5 y) with locally advanced or distant metastatic disease is anecdotally reported. The aim of this study was retrospectively to analyses features of patients (pts) survived more than 4 y with distant metastases in a 15-y cohort of STS attending RMH.

Material & Methods: Inclusion criteria were age >16, locally reviewed diagnosis of STS, a survival >4 y with metastatic disease. All case notes were available for review.

Results: Primary disease. 26 pts with a median age of 31 (17-64) with F/M 11/15 were eligible. 18 pts presented with local disease, 2 with local advanced disease, 6 with local disease and lung metastases, and 1 with local disease but lung metastases could retrospectively be identified 4 y earlier. 18 pts presented with a WHO performance status (PS) 0 and 8 had PS 1. The overall outcome of the primary treatment was disease free (DF) in 16 pts, complete response (CR) in 6 and stable disease (NC) in 4. The median initial disease free survival for 18 pts was 45 months (mths) (1.3-168), mean 48 mths.

Metastatic & advanced disease: 93 treatment courses (metastasectomy (M), chemotherapy (CT), radiotherapy (RT)) were given (46 M, 28 CT, 7 RT, 6 M+CT, 3 CT+M, 2 M+RT, 1 CT+RT). The overall no. of CR was 35 (38%), partial response (PR) 23 (25%), NC 25 (27%), and progressive disease 10 (11%). The overall response rate (CR+PR) was 62% and 12 (46%) pts were DF with a median observation period of 89 mths (37-136). The median and mean no. of CR+PR/pt was 2 (0-5), and CR/pt was 1 (0-5). The no. of pts DF according to histological subtypes was: alveolar soft part sarcoma (ASPS) 4/7 pts, malignant fibrous histiocytoma (MFH) 4/4, synovial sarcoma 2/2, leiomyosarcoma 1/5, Ewing’s sarcoma 1/1, myxoid liposarcoma 0/3, and sarcoma NOS, malignant hemangiopericytoma, epithelioid sarcoma, PNET each 0/1. The overall median survival was 132 mths (58-304+). DF status was obtained with M in 6 pts, CT in 2, M+CT in 1, CT+M in 2, CT+RT in 1.

Conclusion: 3% of pts with metastatic STS may obtain LTS, half of whom remain DF. Factors influencing survival include indolent histology (ASPS, MFH), M and CR with CT.