<b>Brain Metastases and Sarcoma</b>

1. Surg Neurol 2000 Aug;54(2):160-4 
<b>Brain metastasis in patients with sarcoma: an analysis of histological subtypes, clinical characteristics, and outcomes. </b>
Yoshida S, Morii K, Watanabe M, Saito T. Department of Neurosurgery, Niigata Cancer Center Hospital, Niigata, Japan. 

... We examined the incidence and the characteristics of brain metastasis in patients with sarcomas.  ...  All sarcoma patients treated at our institution from 1975 to 1998 were reviewed for brain metastasis.  ...   Brain metastasis was found in 27 (5.6%) of 480 patients with systemic sarcoma (7.2% soft part sarcoma, 3.5% bone sarcoma, 15.1% distant metastasis). Of these 27 sarcoma patients with brain metastases, lung metastasis occurred in 16 patients (59.3%). 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. 
&&url PMID: 11077098  


2. Jpn J Clin Oncol 1999 May;29(5):245-7 
<b>Brain metastases in musculoskeletal sarcomas. </b>
Ogose A, Morita T, Hotta T, Kobayashi H, Otsuka H, Hirata Y, Yoshida S. 
Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Japan. 

...In musculoskeletal sarcomas, brain metastases are rare, but severely affect quality of life. ... All patients with musculoskeletal sarcomas who were treated at our institutions from 1975 to 1997 were reviewed for examples of brain metastasis. 
...Of 480 sarcoma patients, 179 had distant metastases, including 20 patients with brain metastases (4.2%). Alveolar soft part sarcoma (3/4), extraskeletal Ewing's sarcoma (2/8), rhabdomyosarcoma (2/13) and bone Ewing's sarcoma (2/18) tended to metastasize to the brain. All 20 patients had distant or local relapses and 16 of the 20 patients had pulmonary metastases. Three patients underwent surgical treatment and two of them survived over 1 year. Mean survival after diagnosis of brain metastasis was 5.1 months...: Patients with alveolar soft part sarcoma, Ewing's sarcoma, rhabdomyosarcoma and pulmonary metastases have a high risk of brain metastasis. 
&&url PMID: 10379335  



3. Surg Neurol 1998 Apr;49(4):441-4 
<b>Sarcoma metastatic to the brain: a series of 15 cases. </b>
Salvati M, Cervoni L, Caruso R, Gagliardi FM, Delfini R. Department of Neurosurgery, Neurological Mediterranean Neuromed Institute, IRCCS, Pozzilli (IS), Italy. 

We report on 15 patients surgically treated for intraparenchymal brain metastases from sarcoma, including six osteosarcomas, five leiomyosarcomas, two malignant fibrous histiocytomas, and two alveolar soft-part sarcomas (ASPS). 
...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). The two patients with alveolar soft-part sarcomas are alive at 15 and 20 months after surgery. 
...We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from ASPS 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; the presence of concurrent lung metastases is not a contraindication to surgery. 
&&url PMID: 9537665 


4.Am J Clin Oncol 1996 Aug;19(4):351-5 
<b>Late onset of isolated central nervous system metastasis of liposarcoma--a case report. </b>
Arepally G, Kenyon LC, Lavi E. 
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA. 

Metastatic soft-tissue sarcoma of the central nervous system (CNS) is exceedingly rare,,,  
&&url PMID: 8677903 


5. Chir Narzadow Ruchu Ortop Pol 1995;60(1):55-60 
<b>[Surgical treatment of brain metastases from sarcoma]. [Article in Polish] </b>
Wronski M. Oddzialu Neurochirurgii Centrum Onkologii im. Sloana-Ketteringa w Nowym Jorku. 

Brain metastases from sarcoma are rare, and data concerning the treatment and results of therapy are sparse. ,,, Median time from primary diagnosis to diagnosis of brain metastasis was 26.7 months. Lung metastases were present in 21 patients (76%) (8 synchronous with the brain lesion). Pulmonary metastases were resected in 14 patients (50%). The overall median survival time from diagnosis of primary sarcoma was 38.8 months, and from craniotomy was 6.6 months. The presence or absence of lung lesion did not change the median survival calculated from diagnosis of brain metastasis (7 mos and 4.5 mos, respectively, p < 0.48, log-rank test). ,,,. One-year survival was 36% and 2-year survival was 18%. Three patients (12%) survived over 5 years. Since brain metastases from sarcoma are refractory to alternative treatment, surgical excision is indicated when feasible. Brain metastases from sarcoma are uncommon and usually occur in association with or following lung metastasis. Long term survival is possible in a small percentage of patients. 
&&url PMID: 7736836 


6.Gynecol Oncol 1994 Aug;54(2):237-41 
<b>Leiomyosarcoma of the uterus metastatic to brain: a case report and a review of the literature. </b>
Wronski M, de Palma P, Arbit E. Neurosurgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021. 

Central nervous system metastases are an unusual sequela of uterine sarcomas. ,,, Only seven other cases of uterus leiomyosarcoma metastatic to the brain have been published. Review of reported cases 
&&url PMID: 8063254 


7. Neurosurgery 1994 Aug;35(2):185-90; discussion 190-1 
<b>Sarcoma metastatic to the brain: results of surgical treatment. </b>
Bindal RK, Sawaya RE, Leavens ME, Taylor SH, Guinee VF. 
Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston. 

We report on 21 patients surgically treated for intraparenchymal brain metastasis from sarcoma, including ... four leiomyosarcomas, .... Median survival after craniotomy was 11.8 months. 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. The two patients with alveolar soft-part sarcoma are alive at 16 and 25 months after surgery. We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain 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. 
&&url PMID: 7969824 


8. Neurosurgery 1994 Jan;34(1):168-70 
<b>Metastatic alveolar soft part sarcoma presenting as a dural-based cerebral mass. </b>
Perry JR, Bilbao JM. 
Division of Neurology, St. Michael's Hospital, Toronto, Ontario, Canada. 

Sarcoma metastatic to the brain is uncommon and rarely occurs as the initial manifestation of tumor. ....   
&&url PMID: 8121554 


9. Br J Radiol 1993 Nov;66(791):1009-15 
<b>Survival, patterns of spread and prognostic factors in uterine sarcoma: a study of 76 patients. </b>
Moskovic E, MacSweeney E, Law M, Price A. 
Department of Radiology, Royal Marsden Hospital, London, UK. 

We have analysed the medical records and diagnostic imaging of 76 patients presenting to this hospital for treatment of uterine sarcoma between 1970 and 1990. ,,, Bone and brain metastases were uncommon (< 10%). Following diagnosis of relapse, the median survival was 9 months, with the outcome significantly worse if multiple metastatic sites were involved (p < 0.001). No survival benefit was demonstrated from either local radiotherapy or combination chemotherapy once relapse had occurred. Prognostic factors and current policies for the diagnosis and management of uterine sarcomas are discussed. 
&&url PMID: 8281375 


10.  J Heart Lung Transplant 1993 May-Jun;12(3):527-30 
<b>Heart transplantation for cardiac angiosarcoma: should its indication be questioned? </b>
Crespo MG, Pulpon LA, Pradas G, Serrano S, Segovia J, Vegazo I, Salas C, Espana P, Silva L, Burgos R, et al. 
Heart Transplant Unit, Clinica Puerta de Hierro, Madrid, Spain. 

Two men, aged 31 and 32 years, respectively, underwent orthotopic heart transplantation, in both cases to treat primary cardiac angiosarcoma of the right atrium. Total removal of the tumor was performed, and no evidence was found of distant dissemination at the time of surgery. Their postoperative progress was good; however, the patients died 8 and 9 months after transplantation, respectively, of multiple brain metastases. We do not consider heart transplantation to be indicated in the management of malignant cardiac tumors. 
&&url PMID: 8329433 


11. Thorac Cardiovasc Surg 1992 Feb;40(1):48-51 
<b>Leiomyosarcoma of the pulmonary hilar vessels. </b>
Berney CR, Roche B, Kurt AM, Spiliopoulos A, Megevand R. 
Institute of Pathology, University Hospital, Geneva, Switzerland. 

&&url PMID: 1631867 


12. Cancer 1989 Mar 1;63(5):935-8 
<b>Patterns of metastasis in uterine sarcoma. An autopsy study.</b> 
Rose PG, Piver MS, Tsukada Y, Lau T. 
Department of Gynecologic Oncology, Roswell Park Memorial Institute, Buffalo, NY 14263. 

The autopsy findings of 73 patients with uterine sarcoma were studied to determine the sites and possible modes of metastasis. Homologous mixed mesodermal tumors were the most frequent (41%) followed by leiomyosarcoma (26%), heterologous mixed mesodermal tumor (18.3%), stromal sarcoma (12%), and endolymphatic stromal myosis (3%). 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. Metastasis to other distant sites including the brain, heart, kidney, and bone were independent of pelvic and paraaortic nodal metastasis or intraperitoneal disease. Metastatic sites were not different among various histologic types. Distant metastatic sites were statistically associated with lung metastasis. Hematogenous metastasis best explains this metastatic pattern and adjuvant systemic therapy seems indicated. 
&&url PMID: 2914299 


13. Cancer 1988 Feb 1;61(3):593-601 
<b>Sarcoma metastatic to the brain. Lewis AJ. </b>
Department of Pathology, University of Toronto, Ontario, Canada. 

,,, Reportedly, most types of sarcomas are able to metastasize to the brain, and are represented in these 94 patients. ,,, 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  ,,, the presence of lung metastases may increase the probability of brain metastasis occurring subsequently. Review, multicase 
&&url PMID: 3276383 


14. Med Pediatr Oncol 1985;13(5):280-92 
<b>Sarcoma metastatic to the central nervous system parenchyma: a review of the literature. </b>
Sarno JB, Wiener L, Waxman M, Kwee J. 

Sarcoma metastatic to cerebral parenchyma, although rare, occurs more frequently than generally recognized. With increased duration of survival due to multi-modal therapy, more CNS metastases are being found. ,,, 
&&url PMID: 3897818 


15. Cancer 1985 Mar 15;55(6):1382-8 
<b>Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. </b>
Sundaresan N, Galicich JH. 
&&url PMID: 3971308 


16. Arch Surg 1983 Aug;118(8):915-8 
<b>Metastatic patterns in soft-tissue sarcomas. </b>
Vezeridis MP, Moore R, Karakousis CP. 

In 242 patients with recurrent soft-tissue sarcomas, the most common sites of initial recurrence were the primary site in 47.5% of patients and the lungs in 38% of patients. Further recurrences in the course of the disease concerned the lungs, bones, liver, and brain. Total survival and survival after recurrence were influenced by the histologic type, which also affected the site of recurrence. In the management of local recurrence, a five-year disease-free survival rate of 38% was achieved with surgical treatment, while radiation or chemotherapy alone was ineffective. Local recurrences resulted in significantly higher survival rates than those involving other organs. The disease-free interval was a significant prognostic indicator of subsequent survival in the whole group of patients and among those with local recurrence. 
&&url PMID: 6307217 


17. Cancer 1980 Jan 15;45(2):377-80 
<b>Increased incidence of brain metastases in sarcoma patients. </b>
Espana P, Chang P, Wiernik PH. 

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,,, 
&&url PMID: 6243247 


18. Cancer 1975 Nov;36(5):1843-51 
<b>Increased incidence of cerebral metastases in sarcoma patients with prolonged survival from chemotherapy. Report of cases of leiomyosarcoma and chondrosarcoma. </b>
Gercovich FG, Luna MA, Gottlieb JA.
 
Soft tissue and bony sarcomas rarely metastasize to the central nervous system, particularly to the cerebral hemispheres. 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%). ,,,. 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. 
&&url PMID: 1192369 

