Combined treatment of soft tissue sarcomas of the extremities with metastatic bone lesions

Abstract

Relevance. Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, accounting for about 1% of all malignant neoplasms. They are characterized by hematogenous metastasis, with bone metastases occurring in approximately 9-10% of cases. Treatment of STS with bone lesions requires a multimodal approach to achieve radicality and preserve the limb. Study objective. To evaluate the effectiveness of combined treatment of STS of the extremities with metastatic bone lesions. Materials and methods. The study included 17 patients with STS and secondary bone lesions (hip - 9 cases, lower leg - 4, shoulder - 4). Morphological variants: liposarcoma - 6 (35.3%), leiomyosarcoma - 5 (29.4%), undifferentiated sarcoma - 4 (23.5%), synovial sarcoma - 2 (11.8%). The following regimens were used: polychemotherapy with surgery (n=7, 41.2%), radiation therapy with surgery (n=5, 29.4%), chemoradiotherapy with surgery (n=5, 29.4%). Radiation therapy was performed using accelerated fractionation (3.5 Gy × 1 time per day, 5 times per week, total focal dose 32 Gy). Organ-preserving surgeries were accompanied by endoprosthetics of joints or bone segments in 14 cases (82.3%), allotransplantation – in 3 cases (17.7%). Results and discussion. Therapeutic pathomorphosis of III-IV degree was noted in 12 patients (70.6%; 95% CI: 44.0–89.7%). According to RECIST criteria, tumor process stabilization was recorded in 10 patients (58.8%), partial response – in 4 (23.5%), progression – in 3 (17.7%). The average MSTS score was 80.5 ± 15.4%, while good functional results (≥70%) were recorded in 13 patients (76.5%), satisfactory – in 4 (23.5%). Distant metastases were detected in 3 patients (17.7%) within 10 to 18 months, 2 patients (11.8%) died from progression in the lungs with a median follow-up of 22 months. Conclusion. The use of multimodal regimens (chemotherapy, radiation therapy, and chemotherapy) in SMT with metastatic bone lesions allows achieving pronounced therapeutic pathomorphosis, ensuring a high percentage of organ-preserving interventions, and maintaining a satisfactory functional state of the limb.

About the authors

References