Prognostic factors in surgical treatment of the lungs metastases of soft tissue sarcoma

Objective. The  aim  of  this  study  is  to  improve  the  results  of  surgical  treatment  of  lung  metastases  of  soft  tissue sarcomas, to analyze the factors that may affect the effectiveness of surgical treatment.

Materials and methods.The study included 80 patients with metastases of bone sarcomas in the lungs, who received treatment in the period from 2000 to 2013. Among the patients there were 42 (48,5 %) men and 38 (51,5 %) women.

The median age at diagnosis was 33 years (range 17 to 75). The majority of soft tissue sarcomas were represented by malignant  fibrous  histiocytoma  (27,5 %)  and  synovial  sarcoma  (28,5 %).  Almost  all  patients  (96 %)  underwent chemotherapy before surgery for lung metastases. The indication for surgery in most cases (52,5 %) was metastases in the lungs as the only manifestation of the disease. Most often, operations were performed with unilateral lung lesions (67,5 %).

Results. Atypical  lung  resections  58  (72 %)  were  the  most  frequently  performed  volume  of  surgical  intervention, pneumonectomy, bilobectomy and lobectomy were used in 17 (22 %) cases. Combined resections were performed in six patients. Postoperative complications were observed in 6 (7,5 %) patients. The radicality of the operations performed in the study group was 93 % in the R0 volume, in the R1 volume, 4 % of the operations were performed, in the R2 volume, 1 patient was operated on. The most frequent postoperative complication was pneumonia, one patient died in the early postoperative period from complications of surgery. The median follow-up in the study group was 49,2 months (from 3,5 to 239 months). The overall 5-year survival rate in the study group was 41,5 %. Five-year overall survival was more than 30 % higher in the group of patients who had less than 3 metastatic lesions at baseline. Only the following factors have a direct impact on OS indicators: the number and size of metastatic foci, radical removal of metastatic foci, the effect of previous chemotherapy, and the timing of the development of metastatic lesions. In our study, there were also no differences in OS and PFS depending on the surgical approach used.

Conclusion.Surgical treatment is currently fully justified and the only really effective treatment method that can lead to longer-term survival in patients with metastases of sarcomas in the lungs, despite the fact that some metastases have  a  clear  resistance  to  all  types  of  conservative  therapy,  while  The  best  treatment  results  are  achieved  in  the presence of a long disease-free interval (DFI), a small number of metastases and their removal in the R0 volume.