Brain Metastases from Adult Sarcoma: Prognostic Factors and Impact of Treatment. A Retrospective Analysis from the French Sarcoma Group (GSF/GETO)

Author:

Chaigneau Loïc1,Patrikidou Anna2,Ray-Coquard Isabelle3,Valentin Thibaud4,Linassier Claude5,Bay Jacques Olivier6,Moureau Zabotto Laurence7,Bompas Emmanuelle8,Piperno-Neumann Sophie9,Penel Nicolas10,Alcindor Thierry11,Laigre Maryline12,Guillemet Cecile13,Salas Sebastien14,Hugli Anne15,Domont Julien2,Sunyach Marie Pierre3,Lecesne Axel2,Blay Jean Yves3,Nerich Virginie16,Isambert Nicolas17

Affiliation:

1. Department of Medical Oncology, University Hospital Jean Minjoz, Besançon, France

2. Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France

3. Department of Medical Oncology, Centre Leon Berard, Lyon, France

4. Department of Medical Oncology, IUCT-Oncopole, Toulouse, France

5. Department of Medical Oncology, University Hospital, Tours, France

6. Department of Medical Oncology, University Hospital, Clermont-Ferrand, France

7. Department of Medical Oncology, Institut Paoli Calmette, Marseille, France

8. Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes, France

9. Department of Medical Oncology, Institut Curie, Paris, France

10. Department of Medical Oncology, Centre Oscar Lambret, Lille, France

11. Departments of Oncology and Medicine, McGill University, Montreal, Quebec, Canada

12. Department of Oncology, Centre Val D'Aurelle II, Montpelier, France

13. Department of Medical Oncology, Centre Henri Becquerel, Rouen, France

14. Department of Medical Oncology, CH La Timone, Marseille, France

15. Medical Oncologist, Geneva, Switzerland

16. Department of Pharmacy, University Hospital Jean Minjoz, Besançon, France

17. Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France

Abstract

Abstract Background Brain metastases (BM) from adult soft tissue or bone sarcomas are rare, and sparse data exist on their prognostic factors and management. Subjects, Materials and Methods A retrospective study was conducted in 15 centers of the French Sarcoma Group, plus one Canadian and one Swiss center, to report on clinical, histological, and treatment characteristics and to identify predictive factors of outcome. Results Between 1992 and 2012, 246 patients with a median age of 50 years (range: 16–86) were managed for BM. BM included 221 cerebral and cerebellar metastases and 40 cases of meningeal sarcomatosis. The most frequent histopathological subtype was leiomyosarcoma (18.7%). Histological grade was high in 118 (48%) cases. Surgery of BM was carried out for 38 (15.5%) patients. Radiotherapy and chemotherapy were administered in 168 (68.3%) and 91 (37.0%) patients, respectively. Irrespective of treatment modality, BM were controlled in 113 patients (45.9%), including 31 partial responses (12.6%) and 18 complete responses (7.3%). The median overall survival from diagnosis of brain metastasis was 2.7 months (range: 0–133). In the multivariate analysis, the following parameters influenced overall survival: chemotherapy (hazard ratio [HR] = 0.38; 95% confidence interval [CI]: 0.26–0.48), surgery (HR = 0.40; 95% CI: 0.22–0.72), stereotactic radiotherapy (HR = 0.41; 95% CI: 0.19–0.90), whole-brain radiotherapy (HR = 0.51; 95% CI: 0.35–0.76), and grade (HR = 0.65; 95% CI: 0.43–0.98). Conclusion BM of sarcomas are rare and associated with a dismal outcome. Multidisciplinary management with chemotherapy, radiation therapy, and surgery is associated with a better survival. Implications for Practice The incidence of brain and meningeal metastasis in bone and soft tissue sarcomas is estimated between 1% and 8%. Published data are derived from small retrospective case series, often in the pediatric population. A prognostic index is important to guide both clinical decision-making and outcomes research, but one such is lacking for adult sarcoma patients with brain metastases. The current study describes brain metastasis in a large cohort of sarcoma patients. This study, conducted within the French Sarcoma Group, describes the natural history of sarcoma brain metastasis and enables the proposal of strategic recommendations for subsequent clinical trials and for the management of such patients.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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