Chua Clarinda, Raaj Jeevan, Pan Summer, Farid Mohamad, Lee Jin Fu Marcus, Ho Zhen Chong, Sairi Alisa, Sittampalam Kesavan, Tao Miriam, Tay Kevin, Lim Soon Thye, Chin Francis, Teo Melissa, Quek Richard
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Asia Pac J Clin Oncol. 2016 Mar;12(1):e16-22. doi: 10.1111/ajco.12111. Epub 2013 Aug 13.
Brain metastasis is rare in sarcoma. Prognostic factors, optimal management strategies and therapeutic outcomes of such patients are not well studied. We aimed to evaluate the incidence, clinical characteristics and treatment outcomes of parenchymal brain metastasis in sarcoma patients.
This is a single center retrospective analysis. Overall survival (OS) was calculated from the time of diagnosis of brain metastasis to time of death.
Sixteen patients (2.1%) with complete electronic medical records treated at our institution from 2002 to 2010 were identified. Median age was 52 years; 88% had additional sites of metastases. Eight different subtypes of soft tissue and bone sarcoma were identified. Eighty-one percent of the patients developed metachronous brain metastasis at a median of 14 months after initial sarcoma diagnosis. Thirty-eight percent of patients had solitary brain metastasis and 44% underwent aggressive therapy for brain metastasis, defined as either surgical resection or multimodality treatment. The remaining 56% received conservative treatment (either whole brain radiation alone, chemotherapy alone or best supportive care). Median OS for the entire cohort was 3.5 months (95% CI 1.1-6.3 months). A trend toward improved OS was observed with an aggressive treatment approach, 3.7 months versus 1.2 months (P = 0.077) and the usage of chemotherapy (P = 0.071).
Brain metastasis in sarcoma is rare, usually coexists with significant systemic disease and is associated with a grave prognosis. Use of chemotherapy and an aggressive treatment approach in well-selected patients may be associated with improved survival. Prospective studies are needed to confirm these findings.
脑转移在肉瘤中较为罕见。此类患者的预后因素、最佳管理策略及治疗结果尚未得到充分研究。我们旨在评估肉瘤患者实质性脑转移的发生率、临床特征及治疗结果。
这是一项单中心回顾性分析。总生存期（OS）从脑转移诊断时间计算至死亡时间。
确定了2002年至2010年在我们机构接受治疗且拥有完整电子病历的16例患者（2.1%）。中位年龄为52岁；88%有其他转移部位。确定了8种不同亚型的软组织和骨肉瘤。81%的患者在初次肉瘤诊断后中位14个月出现异时性脑转移。38%的患者有孤立性脑转移，44%的患者接受了针对脑转移的积极治疗，定义为手术切除或多模式治疗。其余56%接受了保守治疗（单独全脑放疗、单独化疗或最佳支持治疗）。整个队列的中位OS为3.5个月（95%CI 1.1 - 6.3个月）。积极治疗方法（3.7个月对1.2个月，P = 0.077）和化疗的使用（P = 0.071）观察到OS有改善趋势。
肉瘤中的脑转移罕见，通常与严重的全身疾病共存，且预后不良。在精心挑选的患者中使用化疗和积极治疗方法可能与生存期改善相关。需要前瞻性研究来证实这些发现。
