title: Treating metastatic sarcomas locally: a paradoxe, a rationale, an evidence?
abstract: OBJECTIVE
  The mainstay of first line treatment in metastatic sarcomas is chemotherapy with response rates of ≈25% but the optimal management of further events is debated. We assessed the benefit of local metastatic treatment in metastatic sarcomas.
  
  
  RESULTS
  Local control of local treatment strategies (≈85%) is excellent but highly institution-dependent and subject to selection biases. Formal evidence of an improvement of survival with local ablative treatments has been limited to retrospective studies. On the other hand, some chemotherapy trials are inconclusive because about 20% of patients receive local metastatic ablation as it is considered unethical to omit local treatment in these patients. Further, technology has made surgery, stereotactic irradiation and radiofrequency ablation highly effective on local control with limited morbidity.
  
  
  CONCLUSIONS
  The benefit on survival of metastatic ablation deserves prospective studies integrating quality of life, cost effectiveness and patient-reported outcomes assessment.
authors: Hôpital neuchâtelois, Département d'Oncologie, Chasseral 20, 2300 La Chaux-de-Fonds, Switzerland; Institut régional du Cancer de Montpellier, Parc Euromédecine, 208 rue des Apothicaires, 34298 Montpellier Cedex 5, France.
authors: Timothée
authors: T
authors: Olivier
authors: Centre Hospitalo-Universitaire Pasteur, Service de Chirurgie Thoracique, 30 Avenue de la Voie Romaine, 06000 Nice, France.
authors: Daniel
authors: D
authors: Pop
authors: Hôpital neuchâtelois, Département d'Oncologie, Chasseral 20, 2300 La Chaux-de-Fonds, Switzerland.
authors: Amina
authors: A
authors: Chouiter Djebaili
authors: Centre Antoine Lacassagne, Département d'oncologie, Département de radiothérapie, 227, Avenue de la Lanterne, 06200 Nice, France.
authors: Alexander Tuan
authors: AT
authors: Falk
authors: Centre Antoine Lacassagne, Département de radiologie, 33, Avenue Valombrose, 06189 Nice, France.
authors: Antoine
authors: A
authors: Iannessi
authors: Centre Antoine Lacassagne, Département d'oncologie médicale, 33, Avenue Valombrose, 06189 Nice, France.
authors: Esma
authors: E
authors: Saada
authors: Hôpital neuchâtelois, Département d'Oncologie, Chasseral 20, 2300 La Chaux-de-Fonds, Switzerland.
authors: Willy
authors: W
authors: Nettekoven
authors: Département d'Oncologie, Centre Léon Bérard, 28 Rue Laennec, 69008 Lyon, France.
authors: Jean-Yves
authors: JY
authors: Blay
authors: Centre Hospitalo-Universitaire Saint Roch, Service de Chirurgie, 06000 Nice, France.
authors: Patrick
authors: P
authors: Baque
authors: Institut régional du Cancer de Montpellier, Parc Euromédecine, 208 rue des Apothicaires, 34298 Montpellier Cedex 5, France.
authors: Didier
authors: D
authors: Cupissol
authors: Centre Antoine Lacassagne, Département d'oncologie médicale, 33, Avenue Valombrose, 06189 Nice, France.
authors: Antoine
authors: A
authors: Thyss
authors: Centre Antoine Lacassagne, Département d'oncologie, Département de radiothérapie, 227, Avenue de la Lanterne, 06200 Nice, France. Electronic address: jthariat@hotmail.com.
authors: Juliette
authors: J
authors: Thariat
mesh_terms: D006801:Humans; D008168:Lung / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D009362:Neoplasm Metastasis / Q000473:pathology / Q000628:therapy*; D016634:Radiosurgery; D012509:Sarcoma / Q000473:pathology* / Q000628:therapy*
keywords: Ablative treatment; Chemotherapy; Metastasectomy; Metastases; Sarcoma; Stereotactic radiotherapy