A clinico-morphological study of 95 cases of sarcomas with metastases to the lungs.

Background: Metastasis of soft tissue sarcoma most commonly occurs to the lungs. There are very few studies on histology of pulmonary metastatectomy and hardly any wherein the histology of the primary tumor has been compared with the metastasis. Aims and Objectives: To review histologically all metastatic sarcomas to lung and compare with the primary where available. Materials and Methods: Ninety-five patients with pulmonary metastases from sarcoma were analyzed histologically for type of sarcoma, chemotherapy-related changes, and changes in adjacent lung. Various clinical parameters like laterality, multiplicity, and interval between primary and metastasis were also studied. Results: Osteosarcoma constituted half of the metastatic sarcomas (48 cases, 50.5%) followed by synovial sarcoma (16 cases, 16.8%) and high grade spindle cell sarcoma-NOS (10 cases, 10.5%). The histology of primary and the metastases was similar in 60% of cases of osteosarcoma. Conclusions: Osteosarcoma is the commonest metastatic sarcoma to the lung. There is often a change to fibroblastic histology in patients of conventional osteosarcoma treated with chemotherapy.

Clinical Analysis of Patients who Survived for Less than 3 Months After Brain Metastatectomy

In the patients with brain metastasis (BM), it is impossible to determine who will benefit from surgery because of limited survival. In an attempt to identify optimal candidates for brain metastatectomy, we analyzed patients who survived for <3 months after craniotomy for a single BM lesion. Between January 1st, 1997 and July 31st, 2007, 83 patients with a single BM underwent craniotomy. Of these patients, 25 patients (30.1%) died within 3 months of craniotomy. The primary lesions were non-small call lung cancer in 15, colon cancer in 6, and breast cancer, renal cell carcinoma, ovarian cancer, or esophageal cancer in one apiece. Of the 25 patients, 19 (79%) were of tumor stage IV and had extra-cranial metastasis. Eleven (44%) of the 25 primary cancers had a well-controlled status. Twelve patients (48%) had a Karnofsky Performance Scale (KPS) score of <70, and 13 (52%) were of Recursive Partitioning Analysis (RPA) class 3. Primary cancer status, RPA class, and functional status were found to be critical factors for consideration when selecting surgical candidates. In addition, adjuvant therapy was found to have an important role on survival.

Pulmonary Resection for Lung Metastases from Colorectal Cancer

Isolated lung metastasis occurs in about 1% of all colorectal cancer cases. As in the case of isolated liver metastasis, resection of isolated lung metastasis results in 5 year survival rate of about 30%. PURPOSE: This study was performed to evaluate the survival benefit after pulmonary resection for metastatic colorectal cancer. METHODS: Between January, 1992 and March, 1998, twelve patients underwent lung metastatectomy from colorectal cancer at the Seoul National University Hospital. We evaluated the clinical characteristics of patients and analyzed the follow-up results in 10 patients whose medical records were available. Indications for resection of pulmonary metastasis were complete resection of the primary tumor, no other organ involvement except lung, completely resectable lung lesion, and tolerable general condition of patient for lung resection. RESULTS: Two patients had their primary tumors located in colon and 8 in rectum. Synchronous lung metastases were observed in 3 patients, and 7 patients had metachronous metastases developing 9 to 121 months (median; 33 months) after primary tumor resection. Eight patients had solitary metastatic nodule in lung, while two patients had multiple lesions confined to unilateral lung. Five patients underwent wedge resections, 4 underwent pulmonary lobectomies, and one patient had both wedge resection and lobectomy in unilateral lung. Three patients were lost during the follow-up, but remaining 7 patients are alive after median follow-up of period of 32 months and 6 of these patients have no postoperative recurrence. In addition, four of these 7 patients are alive for more than 3 years after lung metastatectomy. CONCLUSION: Pulmonary metastasis from colorectal cancer without other organ involvement may be a candidate for lung resection. However, further studies are needed to determine the survival benefits after pulmonary resection.