LONG-TERM RESULTS OF COMBINED TREATMENT OF METASTASES OF SARCOMA OF THE MUSCULOSKELETAL SYSTEM IN THE LUNGS

From 2004 to 2014 forty-six patients with sarcomas of the musculoskeletal system with metastatic lesions in the lungs were operated in MRRC. In 22 patients with a primary bone sarcoma metastases were detected in 27% cases, and in 29% of 24 patients with soft tissue sarcomas  metastases were identified at the time of diagnosis. Twenty women and twenty-six men aged 16 to 72 years  (mean age was 39 years) were operated. In most cases metastases were located subpleurally. Solitary metastases were observed in 8 patients (17%), single in 11 (24%) and multiple in 27 (68%) and 18 patients of them had bilateral disease. In all cases, chemotherapy was conducted at the first stage of treatment, according to histology of the tumor. In cases of large metastases or close location to the root of the lung (27 patients) preoperative distal radiotherapy was conducted in hyperfraction regimen with a daily dividing of the dose (2 times a day with an interval of 4 h every other day with single dose of 3 Gy and the total dose of 30 Gy that was isoefficiency to 42 Gy), after that the removal of pulmonary metastases was performed. A total of 73 surgical interventions performed in 46 patients. Most often precision resection of the lung using a neodymium YAG surgical laser MY 40 (wavelength 1318 nm) was performed. One patient underwent pneumonectomy. Videothoracoscopy was used in 6 cases. From 1 to 103 metastases were excised during one intervention. Pneumonia with abscesses were diagnosed in 3 patients, persistent pneumothorax in 5 patients, all complications were treated conservatively. There was no postoperative mortality. Fourteen patients underwent 2 procedures, two patients – 3 procedures, two patients – 4 procedures and one patient had 6 procedures. Follow-up ranged from 3 to 126 months. Twenty-six patients died due to progression of the disease. 3-year and 5-year survival was 46% and 41% respectively. Median survival was 32 months. Thus, the combined treatment of generalized forms of sarcomas of the musculoskeletal system can achieve long-term remission and significantly prolong life. Surgical resection should be applied in patients with solitary and with multiple metastases in the lungs and should be combined with systemic treatment (PCT) and, if indicated, with additional local treatment (distant radiotherapy) of metastases. Precision resection is adequate and well-tolerated method of surgical treatment of metastases in the lungs and does not correlate with severe postoperative complications.

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