title: Effect on survival of local ablative treatment of metastases from sarcomas: a study of the French sarcoma group.
abstract: OBJECTIVE
  Recent data suggest that patients with pulmonary metastases from sarcomas might benefit from ablation of their metastases. Some data are available regarding osteosarcomas/angiosarcomas and lung metastases. The purpose of this study was to assess the efficacy of local ablative treatment on the survival of patients with oligometastases (one to five lesions, any metastatic site, any grade/histology) from sarcomas.
  
  
  METHODS
  A multicentric retrospective study of the French Sarcoma Group was conducted in sarcoma patients with oligometastases who were treated between 2000 and 2012. Survival was analysed using multivariate sensitivity analyses with propensity scores to limit bias.
  
  
  RESULTS
  Of the 281 patients evaluated, 164 patients received local treatment for oligometastases between 2000 and 2012. The groups' characteristics were similar in terms of tumour size and remission of the primary tumours. The median follow-up was 25.7 months; 129 (45.9%) patients had died at this point. The median overall survivals were 45.3 (95% confidence interval = 34-73) months for the local treatment group and 12.6 for the other group (95% confidence interval = 9.33-22.9). Survival was better among patients who received local treatment (hazard ratio = 0.47; 95% confidence interval = 0.29-0.78; P < 0.001). Subgroup analyses revealed similar findings in the patients with single oligometastases (hazard ratio = 0.48; 95% confidence interval = 0.28-0.82; P = 0.007); a significant benefit was observed for grade 3, and a trend was observed for grade 2.
  
  
  CONCLUSIONS
  Local ablative treatment seemed to improve the overall survival of the patients who presented with oligometastatic sarcomas, including soft tissue and bone sarcomas. The survival benefit remained after repeated local treatments for several oligometastatic events. Surgery yielded the most relevant results, but alternative approaches (i.e. radiofrequency ablation and radiotherapy) seemed to be promising. The relevance of these results is strengthened by our analysis, which avoided biases by restricting the population to patients with oligometastatic disease and used propensity scores.
authors.affiliation: Centre Antoine Lacassagne, Nice, France.
authors.forename: A T
authors.initials: AT
authors.lastname: Falk
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.affiliation: Centre Claudius Regaud, Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Ouali
authors.affiliation: Centre Oscar Lambret, Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Penel
authors.affiliation: Institut Bergonié, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Italiano
authors.affiliation: Centre Jean Perrin, Clermont Ferrand, France; Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: J-O
authors.initials: JO
authors.lastname: Bay
authors.affiliation: Institut régional du cancer de Montpellier, Montpellier, France.
authors.forename: T
authors.initials: T
authors.lastname: Olivier
authors.affiliation: Centre Léon Bérard, Lyon, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Sunyach
authors.affiliation: Cochin Teaching Hospital, AP-HP, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Boudou-Roquette
authors.affiliation: Paris Descartes University, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Salas
authors.affiliation: APHM, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Le Maignan
authors.affiliation: CHU Saint Louis, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ducassou
authors.affiliation: Centre Georges-François Leclerc, Dijon, France.
authors.forename: N
authors.initials: N
authors.lastname: Isambert
authors.affiliation: Centre Hospitalier Universitaire, Besançon, France.
authors.forename: E
authors.initials: E
authors.lastname: Kalbacher
authors.affiliation: CHU Henri Mondor, Creteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Pan
authors.affiliation: Centre Antoine Lacassagne, Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Saada
authors.affiliation: Institut Paoli-Calmettes, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Bertucci
authors.affiliation: Centre Antoine Lacassagne, Nice, France.
authors.forename: A
authors.initials: A
authors.lastname: Thyss
authors.affiliation: Centre Antoine Lacassagne, Nice, France. Electronic address: jthariat@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Thariat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000556:secondary* / Q000601:surgery*; D055815:Young Adult
keywords: Local treatment; metastectomy; oligometastases; radiofrequency; radiotherapy; sarcoma