title: Brain, the last fortress of sarcoma: similar dismal outcome but discrepancy of timing of brain metastasis in bone and soft tissue sarcoma.
abstract: OBJECTIVE
  Brain metastasis is a rare but dismal event in sarcomas. However, the pattern of occurrence and the prognostic factors associated with post-brain metastasis survival (PBMS) are not yet well-characterized.
  
  
  METHODS
  Sarcoma patients treated at one institute within 10-year period were retrospectively reviewed and those with brain metastasis were identified. The incidence of brain metastasis was demonstrated by case per person-years and cumulative incidence curves. Univariate factors associated with PBMS were analyzed.
  
  
  RESULTS
  Among 611 sarcoma patients, 20 (3.3%) developed brain metastasis. Alveolar soft part sarcoma (ASPS) and osteosarcoma were the most common subtypes. Overall, the cumulative incidence was 3.9% at 5 years and 8.4% at 10 years. However, the incidence in STS patients continued to rise up to 10 years after primary diagnosis, whereas it reached a plateau in bone sarcoma patients at 3 years. Median PBMS was 1.67 months. Univariate factors associated with better PBMS included ASPS histology, initial surgical treatment, and brain irradiation for non-surgically treated patients.
  
  
  CONCLUSIONS
  Our study revealed a discrepancy in the timing of occurrence of brain metastasis between STS and bone sarcoma. However, patients with brain metastasis had a poor prognosis, implicating the brain as the last fortress of sarcoma.
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Sheng
authors.initials: YS
authors.lastname: Chou
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Liu
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.forename: Tain-Hsiung
authors.initials: TH
authors.lastname: Chen
authors.forename: Paul Chih-Hsueh
authors.initials: PC
authors.lastname: Chen
authors.forename: Hung-Ta Hondar
authors.initials: HT
authors.lastname: Wu
authors.forename: Cheng-Ying
authors.initials: CY
authors.lastname: Shiau
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Wu
authors.forename: Chien-Lin
authors.initials: CL
authors.lastname: Liu
authors.forename: Ta-Chung
authors.initials: TC
authors.lastname: Chao
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
authors.forename: Tai-Tong
authors.initials: TT
authors.lastname: Wong
authors.forename: Chueh-Chuan
authors.initials: CC
authors.lastname: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000473:pathology; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012509:Sarcoma / Q000453:epidemiology* / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D018234:Sarcoma, Alveolar Soft Part / Q000453:epidemiology / Q000473:pathology / Q000556:secondary / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000453:epidemiology* / Q000473:pathology; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology