2677 - Brain Metastases from Soft Tissue Sarcoma
Presenter(s)
S. Vedala1, A. Al-Sharfeen2, O. Haisraely3, S. Perni4, C. Wang5, M. C. Tom6, T. Beckham5, T. A. Swanson7, W. Jiang Jr6, D. N. Yeboa8, M. F. F. McAleer6, C. Chung6, S. L. McGovern3, A. J. Ghia6, J. Li6, A. Patel9, C. Ene10, J. A. Livingston11, A. Farooqi3, and B. De5; 1Texas A&M University, College Station, TX, 2Tilman J. Fertitta Family College of Medicine, Houston, TX, 3Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 5Department of CNS Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 6Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 7University of Texas Medical Branch, Galveston, TX, 8Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 9Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, 10Department of Neurosurgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Houston, TX, 11Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
Purpose/Objective(s): Brain metastases (BM) affect 1-8% of soft tissue sarcoma patients and are associated with poor prognosis, through limited data from small series. The optimal management of central nervous system (CNS) relapse of sarcoma remains unclear. This study aimed to evaluate the diagnosis, management, and outcomes of patients with sarcoma brain metastasis.
Materials/Methods: Records of 167 sarcoma patients diagnosed with 705 brain metastases at a single institution between 2004 and 2023 were reviewed. Most patients were female (57%) and white (64%). The most common primary histologies were spindle cell (17%), Ewing (13%), and alveolar soft part (9%). The Kaplan-Meier method and Cox analyses were used to estimate and determine associations with overall survival (OS).
Results: The median latency from primary tumor to BM diagnosis was 12.9 months (interquartile range [IQR], 4.8-29.2); and 10% of patients presented with BM at primary diagnosis. A majority had extracranial disease at the time of BM diagnosis in the lung (82%) and bone (59%). The median age at BM primary diagnosis was 40 years (range 2-89), and 48% of patients had ECOG of 0-1. The median number of BM at diagnosis was 2 (range 0-31) with a median dominant BM volume of 5.5 cm3 (IQR 1.2-13.5). Local therapy for BM included surgery at 31% and RT at 75% (60% definitive and 15% post operative). RT was whole brain RT in 48%, stereotactic radiosurgery (SRS) in 43% (71% single fraction), and fractionated focal RT in 9%. Systemic therapy following BM diagnosis was administered to 63%.
At a median follow up of 4.5 (IQR, 2.1-11.9) months from BM diagnosis, 9% were alive at last follow up. The median OS after BM diagnosis was 4.7 months (95% CI, 4.0-6.6). One- and two-year OS rates were 28% (95% CI, 21-35%) and 17% (95% CI, 11-21%), respectively. LMD was present in 18% of patients, who had a median survival of 2.9 months (95% CI, 1.6-5.1) with a one-year OS of 14% (95% CI, 4-29%). CNS progression following initial therapy was observed in 41%, at a median of 3.4 months after initial BM diagnosis (IQR 1.8-6.7 months), and subsequent local therapy was administered to 69% of these patients (59% RT). Third and fourth recurrences of BM were observed in 10% and 7% of patients, respectively. On multivariable Cox analysis, older age at diagnosis (HR 1.017; 95% CI 1.005-1.029; P=0.005) and worse performance status as measured by ECOG (HR 1.692; 95% CI 1.075-2.662; P=0.023) were associated with shorter OS, whereas utilization of SRS was associated with longer OS (HR 0.503; 95% CI 0.312-0.812; P=0.005). One-year OS estimates were 42% (95% CI 27-56%) for patients treated with SRS vs. 23% (95% CI 13-35%) for those treated with whole brain RT.Conclusion: Brain metastasis from soft tissue sarcoma is an uncommon and aggressive late-stage development in the history of sarcoma. LMD was present in over one-sixth of patients and carried dismal outcomes. Use of SRS was associated with longer survival after adjustment for clinicopathologic and treatment-related factors.