Brain metastasis in sarcoma: Does metastasectomy or aggressive multi-disciplinary treatment improve survival outcomes.
OBJECTIVE
Brain metastasis is rare in sarcoma. Prognostic factors, optimal management strategies and therapeutic outcomes of such patients are not well studied. We aimed to evaluate the incidence, clinical characteristics and treatment outcomes of parenchymal brain metastasis in sarcoma patients.


METHODS
This is a single center retrospective analysis. Overall survival (OS) was calculated from the time of diagnosis of brain metastasis to time of death.


RESULTS
Sixteen patients (2.1%) with complete electronic medical records treated at our institution from 2002 to 2010 were identified. Median age was 52 years; 88% had additional sites of metastases. Eight different subtypes of soft tissue and bone sarcoma were identified. Eighty-one percent of the patients developed metachronous brain metastasis at a median of 14 months after initial sarcoma diagnosis. Thirty-eight percent of patients had solitary brain metastasis and 44% underwent aggressive therapy for brain metastasis, defined as either surgical resection or multimodality treatment. The remaining 56% received conservative treatment (either whole brain radiation alone, chemotherapy alone or best supportive care). Median OS for the entire cohort was 3.5 months (95% CI 1.1-6.3 months). A trend toward improved OS was observed with an aggressive treatment approach, 3.7 months versus 1.2 months (P = 0.077) and the usage of chemotherapy (P = 0.071).


CONCLUSIONS
Brain metastasis in sarcoma is rare, usually coexists with significant systemic disease and is associated with a grave prognosis. Use of chemotherapy and an aggressive treatment approach in well-selected patients may be associated with improved survival. Prospective studies are needed to confirm these findings.
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Clarinda
C
Chua
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Jeevan
J
Raaj
Biostatistics Unit, Clinical Trials and Epidemiology, National Cancer Centre Singapore, Singapore.
Summer
S
Pan
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Mohamad
M
Farid
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Jin Fu Marcus
JF
Lee
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Zhen Chong
ZC
Ho
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Alisa
A
Sairi
Department of Pathology, Singapore General Hospital, Singapore.
Kesavan
K
Sittampalam
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Miriam
M
Tao
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Kevin
K
Tay
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Soon Thye
ST
Lim
Department of Radiation Oncology, National Cancer Centre Singapore, Singapore.
Francis
F
Chin
Department of Surgical Oncology, National Cancer Centre Singapore, Singapore.
Melissa
M
Teo
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Richard
R
Quek
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
brain metastasis; chemotherapy; radiotherapy; sarcoma; surgery