Brain, the last fortress of sarcoma: Similar dismal outcome but discrepancy of timing of brain metastasis in bone and soft tissue sarcoma

• Published in: Journal of surgical oncology Vol. 104; no. 7; pp. 765 - 770
• Main Authors: Chou, Yi-Sheng, Liu, Chun-Yu, Chen, Wei-Ming, Chen, Tain-Hsiung, Chen, Paul Chih-Hsueh, Wu, Hung-Ta Hondar, Shiau, Cheng-Ying, Wu, Yu-Chung, Liu, Chien-Lin, Chao, Ta-Chung, Tzeng, Cheng-Hwai, Wong, Tai-Tong, Yen, Chueh-Chuan
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2011; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; alveolar soft part sarcoma; Bone Neoplasms - epidemiology; Bone Neoplasms - pathology; brain metastasis; Brain Neoplasms - epidemiology; Brain Neoplasms - pathology; Brain Neoplasms - secondary; Brain Neoplasms - therapy; Female; Humans; Incidence; Male; Middle Aged; osteosarcoma; Osteosarcoma - epidemiology; Osteosarcoma - pathology; Osteosarcoma - secondary; Osteosarcoma - therapy; Prognosis; Risk Factors; Sarcoma - epidemiology; Sarcoma - pathology; Sarcoma - secondary; Sarcoma - therapy; Sarcoma, Alveolar Soft Part - epidemiology; Sarcoma, Alveolar Soft Part - pathology; Sarcoma, Alveolar Soft Part - secondary; Sarcoma, Alveolar Soft Part - therapy; Soft Tissue Neoplasms - epidemiology; Soft Tissue Neoplasms - pathology; soft tissue sarcoma; Survival Analysis; Taiwan - epidemiology; Taiwan
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.22011

Background and Objective Brain metastasis is a rare but dismal event in sarcomas. However, the pattern of occurrence and the prognostic factors associated with post‐brain metastasis survival (PBMS) are not yet well‐characterized. Methods Sarcoma patients treated at one institute within 10‐year period were retrospectively reviewed and those with brain metastasis were identified. The incidence of brain metastasis was demonstrated by case per person‐years and cumulative incidence curves. Univariate factors associated with PBMS were analyzed. Results Among 611 sarcoma patients, 20 (3.3%) developed brain metastasis. Alveolar soft part sarcoma (ASPS) and osteosarcoma were the most common subtypes. Overall, the cumulative incidence was 3.9% at 5 years and 8.4% at 10 years. However, the incidence in STS patients continued to rise up to 10 years after primary diagnosis, whereas it reached a plateau in bone sarcoma patients at 3 years. Median PBMS was 1.67 months. Univariate factors associated with better PBMS included ASPS histology, initial surgical treatment, and brain irradiation for non‐surgically treated patients. Conclusion Our study revealed a discrepancy in the timing of occurrence of brain metastasis between STS and bone sarcoma. However, patients with brain metastasis had a poor prognosis, implicating the brain as the last fortress of sarcoma. J. Surg. Oncol. 2011; 104:765–770. © 2011 Wiley Periodicals, Inc.