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• W2126901365 abstract "Pulmonary metastases (PM) from soft tissue sarcoma (STS) are historically treated with surgery (metastatectomy) or chemotherapy (CT), and patient survival is limited. We questioned whether stereotactic body radiation therapy (SBRT) offers the potential to locally control targeted lesions with limited toxicity, and might prolong survival. All adult (≥18 years) patients with PM from STS seen by orthopedic surgery, medical oncology, or radiation oncology since 1990 were eligible for review. The 58 identified patients (57% male) were 18–88 years old (median 57). Median follow up was 1.4 years (range 0.1−13.5 years). Twenty eight (48.3%) had PM at diagnosis, with a median of 6 nodules. The others demonstrated PM up to 6.2 years later (mean/median 9/17.2 months). CT was usually anthracycline-based. Surgical procedures varied. SBRT used the Novalis Exac Trac patient positioning platform, vacuum bag immobilization, and relaxed end-expiratory breath holding techniques. The PTV = GTV + 0.7–10 mm; dose was prescribed to the isocenter, usually 50 Gy in 10 fractions. Twenty patients (39.2%) were irradiated, and 16 (31.4%) had one or more nodules treated with SBRT (median = 4.5 nodules). Sixteen patients (29.6%) had ≥1 surgical interventions, and 31 (57.4%) received CT. On univariate analysis (Table), patient age, gender, number of PM, surgical intervention, and CT were not associated with overall survival. SBRT (p = 0.012, Hazard ratio = 0.43) (Fig), and any radiation to the lung (p = 0.011, Hazard ratio = 0.71) were beneficial, and PM at diagnosis (p = 0.028, Hazard ratio = 1.87) was adverse. At 2.5 years, survival for SBRT patients was 73% vs. 25% for patients without SBRT (Fig). 12.1% of all patients are currently alive. No patient demonstrated Grade 3 or greater pulmonary toxicity. On multivariate Cox's PH analysis with stepwise selection, SBRT was most significant (p = 0.007). Although most patients with PM from STS die, some patients have prolonged survival. Interestingly, the number of PM did not predict outcome, nor did patient age, suggesting that older patients or patients with greater disease burdens should not be excluded from therapeutic intervention. Of the interventions, SBRT was the most significant predictor for improved survival. Although selection bias clearly exists, it occurs in both directions since some patients considered unfit for chemotherapy or surgery due to co-medical infirmity or large number of PM still receive SBRT, particularly for large or (potentially) obstructive lesions. SBRT should be considered for patients with pulmonary metastatic soft tissue sarcoma.Tabled 1Cox's Propotional HazardVariableLog-rank test (p-value)EstimateStandard errorHazard RatioAge0.730.0070.0101.00Gender0.980.980.291.01SBRT0.012−0.840.350.43Chemotherapy0.990.0050.311.00Radiation to lung0.011−0.340.140.71Surgical intervention0.26−0.210.240.81Metastases @ diagnosis0.0280.630.291.87 Open table in a new tab" @default.
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• W2126901365 date "2007-11-01" @default.
• W2126901365 modified "2023-10-02" @default.
• W2126901365 title "Do Patients With Pulmonary Metastases From Soft Tissue Sarcoma Benefit From Stereotactic Body Radiation Therapy" @default.
• W2126901365 doi "https://doi.org/10.1016/j.ijrobp.2007.07.2314" @default.
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