Postdoctoral scholar Stanford University, School of Medicine
Introduction: Brain metastases (BM) secondary to sarcoma are rare and their incidence range from 1 to 8% of all bone and soft tissue sarcoma. Although stereotactic radiosurgery (SRS) is widely used for brain metastases there are only a few papers reporting SRS used for sarcoma metastasizing to the brain. The purpose of this study is to evaluate the safety and effectiveness of SRS for sarcoma BM.
Methods: We retrospectively reviewed the clinical and radiological outcomes of the patients with BM secondary to histopathologically confirmed sarcoma treated with SRS, either as primary or as adjuvant treatment after surgery at our institute between January 2005 and September 2022.
Results: A total of 23 patients with sarcoma (9 females) with 150 BM secondary to sarcoma were treated with CyberKnife SRS. The median age at the time of treatment was 50 years(range: 4-76). The most common primary sites were the heart, lungs, uterus, upper extremities, chest wall, and head and neck. The most common histological subtypes were undifferentiated/high-grade pleomorphic sarcoma, spindle cell tumor, leiomyosarcoma, synovial sarcoma, and other less common ones. The median KPS score on presentation was 70(range: 40-100). Eight patients were treated with SRS as a primary treatment and 15 patients with SRS as an adjuvant treatment after surgery to the resection cavity. The median tumor volume was 24.1cc (range:0.1-150.3), the median marginal dose was 24Gy(range:18-30), and the median follow-up was 3 months(range:1-16). The median progression-free survival and overall survivals were 5.3 months(range:0.4-32) and 8.2months(range:0.1-40), respectively. The 3- and 6-month local tumor control rates for lesions were 82% and 78%, respectively. There were no radiation-induced adverse effects.
Conclusion : SRS, both as a primary treatment and as an adjuvant treatment to the resection cavity after a surgery is a safe and relatively effective treatment modality for sarcoma BM. Larger studies aiming to validate our results are encouraged.
