DEVELOPMENT AND TREATMENT OF PULMONARY METASTASES IN ADULT PATIENTS WITH EXTREMITY SOFT-TISSUE SARCOMA

Objective: The authors reviewed a series of adult patients with extrem ity soft tissue sarcoma to determine the incidence of pulmonary metast ases and outcome after treatment. Methods: Of 716 patients admitted be tween January 1983 and December 1990, 135 (19%) had isolated pulmonary metastases as the initial site of distant recurrence. Fifty-eight per cent (78 of 135) of the patients were treated surgically, and 83% of t hem had their tumors completely resected. Results: The median survival after complete resection was 19 months; incomplete resection, 10 mont hs; and no operation, 8 months (p = 0.005). The 3-year survival rate a fter complete resection was 23%, compared with a 2% rate (1 of 57) in those treated nonsurgically (p < 0.001). Factors associated with an in creased risk of pulmonary metastases included high tumor grade, tumor size greater than 5 cm, lower extremity site, and histologic type (spi ndle cell, tendosynovial, and extraskeletal osteosarcoma). Factors ass ociated with complete resectability were the histologic types of spind le cell and extraskeletal osteosarcoma. Conclusions: Complete surgical resection remains the only possibility for cure from pulmonary metast ases in soft tissue sarcoma; however, only 11% of the 19% of patients with an extremity sarcoma whose first distant recurrence is in the lun g will be alive at 3 years, despite therapy. Complete resection and th e development of more effective adjuvant treatments are imperative to improve outcome for this group of patients.