title: Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma.
abstract: OBJECTIVE
  The authors reviewed a series of adult patients with extremity soft tissue sarcoma to determine the incidence of pulmonary metastases and outcome after treatment.
  
  
  METHODS
  Of 716 patients admitted between January 1983 and December 1990, 135 (19%) had isolated pulmonary metastases as the initial site of distant recurrence. Fifty-eight percent (78 of 135) of the patients were treated surgically, and 83% of them had their tumors completely resected.
  
  
  RESULTS
  The median survival after complete resection was 19 months; incomplete resection, 10 months; and no operation, 8 months (p = 0.005). The 3-year survival rate after complete resection was 23%, compared with a 2% rate (1 of 57) in those treated nonsurgically (p < 0.001). Factors associated with an increased risk of pulmonary metastases included high tumor grade, tumor size greater than 5 cm, lower extremity site, and histologic type (spindle cell, tendosynovial, and extraskeletal osteosarcoma). Factors associated with complete resectability were the histologic types of spindle cell and extraskeletal osteosarcoma.
  
  
  CONCLUSIONS
  Complete surgical resection remains the only possibility for cure from pulmonary metastases in soft tissue sarcoma; however, only 11% of the 19% of patients with an extremity sarcoma whose first distant recurrence is in the lung will be alive at 3 years, despite therapy. Complete resection and the development of more effective adjuvant treatments are imperative to improve outcome for this group of patients.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: M A
authors.initials: MA
authors.lastname: Gadd
authors.forename: E S
authors.initials: ES
authors.lastname: Casper
authors.forename: J M
authors.initials: JM
authors.lastname: Woodruff
authors.forename: P M
authors.initials: PM
authors.lastname: McCormack
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011013:Pneumonectomy; D011446:Prospective Studies; D012509:Sarcoma / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology*; D015996:Survival Rate