ASPS patients benefit from the brain mets surgery

[Olga]

The 2014 Connective Tissue Oncology Society meeting
Poster 40
BRAIN METASTASES IN SARCOMA PATIENTS, THE ROYAL MARSDEN HOSPITAL EXPERIENCE 1998 TO 2013: OUTCOMES AND PROGNOSTIC VARIABLES
Thomas M. Richards, MBBS, BSc, MRCP, FRCR1; Attilla Kollar1; Robert Urwin1; Komel Khabra2;
Omar Al-Muderis1; Charlotte Benson1; Mark Linch1;
Ian Judson1; Aisha Miah, MRCP FRCR PhD1
1The Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom;
2The Statistics Unit, The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
Objective: Brain metastases (BM) have a low incidence, ~5-6% in sarcoma patients. Few studies have investigated the demographics and impact of local treatments in this poor prognosis sub-group or assessed prognostic variables associated with outcome.
Methods: A prospective database, collected at The Royal Marsden Hospital (RMH) from 1998-2013, recorded all patients presenting with BM who have a diagnosis of soft-tissue or bone sarcoma. Patient records were retrospectively reviewed to assess demographics, treatment and survival outcomes. Sequential univariate-multivariate analyses were performed to assess 7 variables for an independent association with survival.
Results: Between 02/1998 and 02/2013 eighty-nine patients with a primary sarcoma were diagnosed with BM. At a median follow-up of 4.8 years, 3 (3.2%) patients were alive. Mean patient age (range) was 47 years (18.4-89) with 55 (61.8%) male. Most frequent histologies were leiomyosarcoma (LMS) and pleomorphic sarcoma with 14 patients (15.7%) in each category. Primary tumour site was the limb in 33 (37.1%) patients. Median time (range) from diagnosis to detection of BM was 15.3 months (0-167.1) with a median (IQR) of 2 (1-4) BM detected. Following BM diagnosis, 68 patients received active treatment with whole brain or stereotactic radiotherapy (RT) (n=51), surgery (S) (n=5) or combination (C) of RT and surgery (n=12). Median (95% C.I.) survival (months) after RT, S or C was 3.2 (2.5-3.8 ), 18.1 (0-43.3) and 18.6 (14.4-22.7) respectively compared to best supportive care (BSC) of 1.1 (0-2.3). Variables, independently associated (p<0.05) with survival (Hazard Ratio, 95% C.I.) were the presence of extra-cranial disease (4.14, 1.66-10.31), age at BM diagnosis (1.03, 1.01-1.04), LMS (0.22, 0.1-0.5), alveolar soft-part sarcoma histology (0.3, 0.1-0.89) and surgical excision of BM (0.18, 0.09-0.39).
Conclusion: Patients who received surgery or combination treatment for BM had improved survival compared to best supportive care. Five variables were found to be significantly associated with survival and may be useful prognostic markers, to determine benefit of intervention in this uncommon sarcoma sub-group.

Olga
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