

"The autopsy findings of 73 patients with uterine sarcoma were studied to determine the sites and possible modes of metastasis. [26% of the tumor types were LMS] The peritoneal cavity and omentum were the most frequently involved sites (59%), followed by the lung (52%), pelvic lymph nodes (41%), paraaortic lymph nodes (38%), and liver parenchyma (34%). The presence of lung metastasis was not associated with pelvic or paraaortic node metastasis or intraperitoneal disease. <b>Metastasis to other distant sites including the brain, heart, kidney, and bone were independent of pelvic and paraaortic nodal metastasis or intraperitoneal disease.</b> Metastatic sites were not different among various histologic types. <b>Distant metastatic sites were statistically associated with lung metastasis.</b>  Hematogenous metastasis best explains this metastatic pattern..."[12]

Soft tissue and bony sarcomas rarely metastasize to the brain.  [1,2,5,6,8,9,18] Data concerning the treatment and results of therapy are sparse [5]  <b>Sarcoma and leiomyosarcoma metastatic to the brain is uncommon and rarely occurs as the initial manifestation of tumor.  Central nervous system metastases are an unusual sequela of leiomyosarcoma. The incidence of brain metastases from systemic sarcoma has been reported as 7% or less.</b>  [2]

If sarcoma does metastasize to the brain, it is often after lung metastases [approximately 60% of those with brain metastases will have had or have lung metastases. [1,5]  Although the numbers are small, the increased incidence of cerebral metastases in the group relapsing after a lengthy response suggests that improved chemotherapy for sarcomas resulting in improved survival may be changing the pattern of metastatic disease, and may require new therapeutic approaches.[18]

<b>"Treatment allowing longer survival may be allowing brain metastases to become noticeable.  With increased duration of survival due to multi-modal therapy, more CNS metastases are being found.</b> A literature search occasioned by a patient with metastatic sarcoma has produced some interesting results"  [14]

" In 456 patients with metastatic sarcoma, only 6 (1.3%) had cerebral metastases documented by brain scan at the time of referral for chemotherapy. Adriamycin-containing combination chemotherapeutic regimens have led to a significant increase in the median survival of patients from the start of chemotherapy (18 + months for responders compared, to 7 months in nonresponders). Of 14 patients relapsing after a response or stabilization of disease of 6 months or greater, the cause of relapse was the development of cerebral metastases in 5 (36%). Two of these cases, one a patient with leiomyosarcoma and one with chondrosarcoma, were documented by autopsy and are reported in detail because of their rarity in the medical literature." [18]

"Eleven cases of brain metastases that developed in 114 sarcoma patients are presented. Two of 11 patients presented with brain metastasis at the time of diagnosis and the other nine developed them later. The high incidence of brain metastases in patients with rhabdomyosarcoma (26%) and malignant fibrous histiocytoma (27%), two types of tumor which supposedly metastasize rarely to the brain, is remarkable. The increased incidence of brain metastases may be related to longer survival of sarcoma patients and to the inability of AMN and other drugs used in the treatment of sarcomas to cross the blood-brain barrier. Preventive treatment of brain metastases with drugs active in the CNS or with radiotherapy following the diagnosis of pulmonary metastases, could be useful, especially in patients with rhabdomyosarcoma and malignant fibrous histiocytoma" [17]

"There may be a group of tumors, including malignant fibrous histiocytoma, rhabdomyosarcoma, and perhaps leiomyosarcoma and osteosarcoma, in which the incidence of brain metastases has increased with improved sarcoma chemotherapy (CT). In this group particularly, but also in alveolar soft-part sarcoma and others, the presence of lung metastases may increase the probability of brain metastasis occurring subsequently." [13]

"Since brain metastases from sarcoma are refractory to alternative treatment, surgical excision is indicated when feasible". [5]

"In one series where sarcoma was surgically resected, one-year survival was 36% and 2-year survival was 18%. Three patients (12%) survived over 5 years. "[5]

"Out of 10 patients surgically treated, 8 patients survived more than 16 months. Median survival period after craniotomy was 25.4 months. ... We recommend aggressive treatment for those patients with brain metastases whose performance scores are over 70."[1]

"We report on 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including ... four leiomyosarcomas, .... Median survival after craniotomy was 11.8 months.<b> Patients with a preoperative Karnofsky performance score of > 70 survived for 15.7 versus 6.6 months for those with a Karnofsky performance score < or = 70. Patients undergoing complete resection survived 14.0 versus 6.2 months for patients undergoing incomplete resection. Patients with evidence of lung metastases at the time of surgery survived 11.8 months, which was similar to the 10.5-month survival for patients with disease limited to the brain. .... We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain</b> and that patients with metastasis from alveolar soft-part sarcoma may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis, whereas the presence of concurrent lung metastases is not a contraindication to surgery."[7]

"Of 480 sarcoma patients, 179 had distant metastases, including 20 patients with brain metastases (4.2%). ,,, Three patients underwent surgical treatment and two of them survived over 1 year. Mean survival after diagnosis of brain metastasis was 5.1 months".[2]

In a series of sarcoma brain metastases: "Median survival after craniotomy was 9.3 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 12.8 versus 5.3 months for those with a Karnofsky performance score < 70 (p=0.03). Patients with evidence of only lung metastases at the time of surgery (nine cases) survived 8.6 months, which was similar to the 10.4-month survival for patients with disease limited to the brain (p=0.1). ,,,". [3]
<b>"...We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain ,,,. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis; the presence of concurrent lung metastases is not a contraindication to surgery.</b>[3]
