title: Local control of metastatic sarcoma.
abstract: OBJECTIVE
  Survival rates for children with metastatic sarcoma have remained dismal despite intensified multiagent chemotherapy protocols. The local treatment of metastatic disease has been promoted as a way to eliminate colonies of genetically unstable, heterogeneous metastatic cells in an attempt to improve survival amongst this most unfortunate patient population.
  
  
  RESULTS
  The survival benefit offered by pulmonary metastasectomies in patients with metastatic osteosarcoma is well substantiated. Utilization of other local treatment modalities, such as radiation therapy and percutaneous thermal ablation, offers the opportunity to intervene in a wide range of pulmonary and extrapulmonary metastatic disease. Patients who have the entirety of their identifiable disease addressed by local control modalities consistently demonstrate improved survival compared with patients who are treated with systemic therapy in isolation.
  
  
  CONCLUSIONS
  The current state of the literature prevents a definitive conclusion about the utility of local control for metastatic sarcoma. The retrospective trials are clouded by selection bias and the prospective studies are designed to address alternative questions. However, the techniques utilized for local control impart minimal risk to the patient and, in amenable cases, have been shown to provide an opportunity to effect a cure in children with an otherwise dismal prognosis.
authors.affiliation: Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Lerman
authors.forename: R Lor
authors.initials: RL
authors.lastname: Randall
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000473:pathology* / Q000628:therapy; D017115:Catheter Ablation / Q000639:trends; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D059146:Metastasectomy / Q000639:trends; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000639:trends; D012509:Sarcoma / Q000556:secondary* / Q000628:therapy; D016019:Survival Analysis