Chan Chung Ming, Lindsay Adam D, Spiguel Andre Rv, Scarborough Mark T, Gibbs C Parker
Division of Orthopaedic Oncology, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Rare Tumors. 2020 Sep 29;12:2036361320960060. doi: 10.1177/2036361320960060. eCollection 2020.
Brain metastases are a rare occurrence in patients with sarcoma. The prognosis for patients is poor, and treatment can contribute to considerable morbidity. We sought to examine the experience of our institution in managing these patients over a period of 17 years. We performed a retrospective cohort study of patients managed for sarcoma of the extremity or trunk who developed brain metastases from 2000 to 2017. Clinical data were analyzed and we assessed survival outcomes. 14 patients presenting at a mean age of 46.7 years were included. All patients were treated with radiotherapy for their brain metastases. 3 patients underwent surgical excision of their intracranial metastases. Two patients were treated with radium-223 dichloride. Kaplan-Meier survival analysis and the log rank test were used to calculate the survival probability, and to compare patient subgroups. All patients in this study developed lung or bone metastases at a mean interval of 13.3 months prior to the development of brain metastasis. The median interval from diagnosis of a brain metastasis to death was 3.6 months. The Kaplan-Meier survival probability at 6 months was 28.6%, and 14.3% at 1 year. Surgery was not found to be associated with increased survival. Patients with cerebellar metastasis had increased survival probability as compared to those with cerebral metastasis. Patients with extremity or trunk sarcoma who develop brain metastases frequently develop lung or bone metastases in the year preceding their diagnosis of brain metastasis. Patients with cerebellar metastasis may have better survival than those with cerebral metastasis, and an aggressive treatment approach should be considered. Despite aggressive treatment, the prognosis is grim.
脑转移在肉瘤患者中较为罕见。患者预后较差，治疗可能会导致相当大的发病率。我们试图研究本机构在17年期间管理这些患者的经验。我们对2000年至2017年期间因四肢或躯干肉瘤发生脑转移而接受治疗的患者进行了回顾性队列研究。分析临床数据并评估生存结果。纳入了14名平均年龄为46.7岁的患者。所有患者均接受了脑转移瘤的放射治疗。3例患者接受了颅内转移瘤的手术切除。2例患者接受了二氯化镭-223治疗。采用Kaplan-Meier生存分析和对数秩检验来计算生存概率，并比较患者亚组。本研究中的所有患者在发生脑转移前平均13.3个月出现了肺或骨转移。从脑转移诊断到死亡的中位间隔时间为3.6个月。6个月时的Kaplan-Meier生存概率为28.6%，1年时为14.3%。未发现手术与生存率提高相关。与脑转移患者相比，小脑转移患者的生存概率增加。发生脑转移的四肢或躯干肉瘤患者在诊断脑转移前一年经常出现肺或骨转移。小脑转移患者的生存可能比脑转移患者更好，应考虑积极的治疗方法。尽管采取了积极治疗，但预后仍很严峻。
