PRIMARY SARCOMAS OF THE MEDIASTINUM - RESULTS OF THERAPY

Primary sarcomas of the mediastinum are rare, and data concerning trea tment and results of therapy are sparse, Objective: To assess presenta tion, management, prognostic factors, and survival in mediastinal sarc omas. Methods: We reviewed our experience,vith 47 patients with the di agnosis of primary sarcoma of the mediastinum, Data were collected fro m a computerized institutional database and medical records, Survival was analyzed by Kaplan-Meier method and comparisons of survival by log rank test. Results: The median age of 47 patients with mediastinal sa rcoma was 39 years (range 2.5 to 69 years), with a male/female ratio o f 1.6, The most common complaints were chest/shoulder pain (38%) and d yspnea (23%), The most common tumor types were malignant peripheral ne rve tumor (26%), spindle cell sarcoma (15%), leiomyosarcoma (9%), and liposarcoma (9%). Operation was the primary treatment modality in 72% of cases (n = 34); 22 sarcomas (47%) were completely resected, The ove rall 5-year survival was 32%. High-grade lesions had a significantly d ecreased survival (5-year survival = 27%) compared with low-grade tumo rs (5-year survival = 66%) (p = 0.05), The overwhelming factor determi ning survival was the ability to completely resect the tumors (5-year survival 49% for complete resection; 3-year survival 18% for incomplet e or no resection) (p = 0.0016), Despite complete resection, local rec urrence occurred in 64% of cases, Conclusion: Because the overall surv ival for patients with mediastinal sarcomas is 32% and the local recur rence is 64% for tumors completely resected, aggressive adjuvant thera py should continue to be systematically explored.