Surgical management of metastatic sarcoma to the brain

Clinical article

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Metastatic sarcoma to the brain is rare and represents a therapeutic challenge due to its relative resistance to radio- and chemotherapy. Resection has traditionally been the mainstay of treatment. The authors reviewed a series of patients with metastatic sarcoma to the brain treated surgically to determine outcomes and identify predictors of survival in these patients.


A retrospective review of prospectively collected data was undertaken on patients undergoing surgery between 1993 and 2005 for metastatic sarcoma to the brain at The University of Texas, M.D. Anderson Cancer Center.


During the study period, 62 patients underwent 84 operations for metastatic sarcoma to the brain. The median postoperative overall and progression-free survival rates were 7.5 and 4.7 months, respectively. Fifty-nine (95%) of 62 patients had a gross-total resection. The 30-day mortality rate was 4.2%. The Karnofsky Performance Scale scores at discharge from the hospital and 3 months postoperatively were the same or improved in 50 (85%) of 59 and 26 (51%) of 51, respectively. Overall postcraniotomy survival was 62% at 6 months, 39% at 1 year, 21% at 2 years, and 8% at 5 years. In multivariate and univariate analysis, control of systemic disease, and sarcomas originating from bone, cartilage, or soft tissue were predictors of survival. Patients with control of systemic disease had survival advantage when compared with those who did not. In patients with alveolar soft-part sarcoma, there was a significantly increased survival advantage compared with all other histological subgroups.


The authors' results suggest that in selected patients, resection of metastatic sarcoma to the brain is associated with a relatively low risk of operative death and results in improvement in neurological function. Patients with systemic control of their primary disease and certain histological subtypes (specifically alveolar soft-part sarcoma) have improved overall and progression-free survival.

Abbreviations used in this paper: ASPS = alveolar soft-part sarcoma; CI = confidence interval; GTR = gross-total resection; KPS = Karnofsky Performance Scale; PFS = progression-free survival; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy.

Article Information

Address correspondence to: Ganesh Rao., M.D., Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard Unit 442, Houston, Texas 77030. email:

Please include this information when citing this paper: published online October 3, 2008; DOI: 10.3171/2008.4.17505

© AANS, except where prohibited by US copyright law.



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    Kaplan-Meier survival curve showing the overall survival of the 59 patients who had GTR of their metastatic sarcoma lesions. The median survival was 7.5 months.

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    Kaplan-Meier survival curve comparing patients with control of systemic disease with those without. The difference between the curves is statistically significant (p = 0.03, log-rank test).

  • View in gallery

    Kaplan-Meier survival curve comparing ASPS histology to all other sarcoma histologies. The difference between curves is statistically significant (p = 0.003, log-rank test).





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