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Prognostic Value of Computed Tomography for Monitoring Pulmonary Metastases in Soft Tissue Sarcoma Patients after Surgical Management: A Retrospective Cohort Study

Abstract

Background

The lung is the most common site of metastases in patients with a soft tissue sarcoma. However, surveillance protocol for pulmonary metastasis after surgical management has not been proved. The goal of this retrospective study was to evaluate the prognostic value of computed tomography of the chest in soft tissue sarcoma patients after surgery.

Methods

A retrospective study was performed on 176 patients who were followed up with chest computed tomographic (CT) scan or plain chest radiographs for pulmonary metastasis monitoring after surgery. Ninety-six patients were followed up with plain chest radiographs and 80 patients with chest CT scan. Mean duration of follow-up was 55.8 months. The Kaplan-Meier method and the log-rank test were used to calculate overall survival rates and survival rate difference between chest CT and plain radiograph cohorts.

Results

The overall 5- and 10-year survival rates of 176 patients were 75.6% and 70.3%, respectively. The 5-year survival estimates of 96 patients who were included in the plain radiograph cohort and 80 patients in the chest CT cohort were 74.2% and 76.6%, respectively (P = 0.70). Fifty-four patients (30.7%) had pulmonary metastasis. Of the 54 patients, 26 belonged to the plain radiograph cohort and 28 patients belonged to the chest CT cohort. Pulmonary metastasis of chest CT cohort had the tendencies of unilaterality, a smaller number of patients, and management with metastasectomy other than palliative management. The 2- and 4-year survival ratess after detection of pulmonary metastasis were 20.1% and 0% in the plain radiograph cohort and 47.4% and 31.6% in the chest CT cohort (P < 0.05).

Conclusion

Serial monitoring with chest CT could give rise to early detection of pulmonary metastases, chance for metastasectomy, and eventually survival advantage.

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References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59:225–49.

    PubMed  Article  Google Scholar 

  2. Gadd MA, Casper ES, Woodruff JM, McCormack PM, Brennan MF. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg. 1993;218:705–12.

    PubMed  Article  CAS  Google Scholar 

  3. Billingsley KG, Burt ME, Jara E, Ginsberg RJ, Woodruff JM, Leung DH, et al. Pulmonary metastases from soft tissue sarcoma: analysis of patterns of diseases and postmetastasis survival. Ann Surg. 1999;229:602–10.

    PubMed  Article  CAS  Google Scholar 

  4. Brennan MF, Casper ES, Harrison LB, Shiu MH, Gaynor J, Hajdu SI. The role of multimodality therapy in soft-tissue sarcoma. Ann Surg. 1991;214:328–36.

    PubMed  Article  CAS  Google Scholar 

  5. Pisters PW, Harrison LB, Leung DH, Woodruff JM, Casper ES, Brennan MF. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol. 1996;14:859–68.

    PubMed  CAS  Google Scholar 

  6. Potter DA, Kinsella T, Glatstein E, Wesley R, White DE, Seipp CA, et al. High-grade soft tissue sarcomas of the extremities. Cancer. 1986;58:190–205.

    PubMed  Article  CAS  Google Scholar 

  7. NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. Version 2008. Fort Washington, PA.

  8. Fleming JB, Cantor SB, Varma DG, Holst D, Feig BW, Hunt KK, et al. Utility of chest computed tomography for staging in patients with T1 extremity soft tissue sarcomas. Cancer. 2001;92:863–8.

    PubMed  Article  CAS  Google Scholar 

  9. Porter GA, Cantor SB, Ahmad SA, Lenert JT, Ballo MT, Hunt KK, et al. Cost-effectiveness of staging computed tomography of the chest in patients with T2 soft tissue sarcomas. Cancer. 2002;94:197–204.

    PubMed  Article  Google Scholar 

  10. Whooley BP, Gibbs JF, Mooney MM, McGrath BE, Kraybill WG. Primary extremity sarcoma: what is the appropriate follow-up? Ann Surg Oncol. 2000;7:9–14.

    PubMed  Article  CAS  Google Scholar 

  11. Whooley BP, Mooney MM, Gibbs JF, Kraybill WG. Effective follow-up strategies in soft tissue sarcoma. Semin Surg Oncol. 1999;17:83–7.

    PubMed  Article  CAS  Google Scholar 

  12. Kane JM 3rd. Surveillance strategies for patients following surgical resection of soft tissue sarcomas. Curr Opin Oncol. 2004;16:328–32.

    PubMed  Article  Google Scholar 

  13. Lord HK, Salter DM, MacDougall RH, Kerr GR. Is routine chest radiography a useful test in the follow up of all adult patients with soft tissue sarcoma? Br J Radiol. 2006;79(946):799–800.

    PubMed  Article  CAS  Google Scholar 

  14. Rehders A, Hosch SB, Scheunemann P, Stoecklein NH, Knoefel WT, Peiper M. Benefit of surgical treatment of lung metastasis in soft tissue sarcoma. Arch Surg. 2007;142:70–5.

    PubMed  Article  Google Scholar 

  15. Jablons D, Steinberg SM, Roth J, Pittaluga S, Rosenberg SA, Pass HI. Metastasectomy for soft tissue sarcoma. Further evidence for efficacy and prognostic indicators. J Thorac Cardiovasc Surg. 1989;97:695–705.

    PubMed  CAS  Google Scholar 

  16. Verazin GT, Warneke JA, Driscoll DL, Karakousis C, Petrelli NJ, Takita H. Resection of lung metastases from soft-tissue sarcomas. A multivariate analysis. Arch Surg. 1992;127:1407–11.

    PubMed  CAS  Google Scholar 

  17. Ueda T, Uchida A, Kodama K, Doi O, Nakahara K, Fujii Y, et al. Aggressive pulmonary metastasectomy for soft tissue sarcomas. Cancer. 1993;72:1919–25.

    PubMed  Article  CAS  Google Scholar 

  18. Smith R, Pak Y, Kraybill W, Kane JM 3rd. Factors associated with actual long-term survival following soft tissue sarcoma pulmonary metastasectomy. Eur J Surg Oncol. 2009;35:356–61.

    PubMed  Article  CAS  Google Scholar 

  19. Casson AG, Putnam JB, Natarajan G, Johnston DA, Mountain C, McMurtrey M, et al. Five-year survival after pulmonary metastasectomy for adult soft tissue sarcoma. Cancer. 1992;69:662–8.

    PubMed  Article  CAS  Google Scholar 

  20. Putnam JB Jr, Roth JA, Wesley MN, Johnston MR, Rosenberg SA. Analysis of prognostic factors in patients undergoing resection of pulmonary metastases from soft tissue sarcomas. J Thorac Cardiovasc Surg. 1984;87:260–8.

    PubMed  Google Scholar 

  21. Roth JA, Putnam JB Jr, Wesley MN, Rosenberg SA. Differing determinants of prognosis following resection of pulmonary metastases from osteogenic and soft tissue sarcoma patients. Cancer. 1985;55:1361–6.

    PubMed  Article  CAS  Google Scholar 

  22. Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Pulmonary metastasectomy in patients with soft tissue sarcomas: experiences in 50 patients. Thorac Cardiovasc Surg. 2006;54:489–92.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgment

This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (A084177).

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Correspondence to Han-Soo Kim MD.

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Cho, H.S., Park, IH., Jeong, W.J. et al. Prognostic Value of Computed Tomography for Monitoring Pulmonary Metastases in Soft Tissue Sarcoma Patients after Surgical Management: A Retrospective Cohort Study. Ann Surg Oncol 18, 3392–3398 (2011). https://doi.org/10.1245/s10434-011-1705-4

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Keywords

  • Soft Tissue Sarcoma
  • Pulmonary Metastasis
  • Chest Compute Tomographic
  • Malignant Peripheral Nerve Sheath Tumor
  • Pulmonary Metastasectomy