Management of oligometastatic disease in soft tissue sarcomas

Abstract

Oligometastatic soft tissue sarcoma represents an intermediate state between localized and disseminated disease. Combination A combination of surgery, radiotherapy and systemic treatment significantly improves prognosis, with a 5-year overall survival as high as 50%. Due to the high prevalence of lung metastases, most of the surgical evidence is centered around lung metastasectomy. The decision to perform surgical metastasectomy remains dependent on optimal patient selection. Adequate post-surgical lung function, absence of extrapulmonary metastases, control of the primary tumor, and feasibility of achieving negative margins are major criteria for patients to undergo successful surgery. Adequate margins, longer disease-free interval, unilateral, limited number (≤ 2), metachronous and small (< 2 cm) pulmonary metastasis are some factors associated with improved survival. Radiotherapy, especially SBRT, is an effective treatment for disease control, and its use as (neo)-adjuvant therapy has shown promising results. However, studies comparing radiotherapy against surgery are missing and the efficacy of radiotherapy independent of surgery is not yet clear. Interventional radiology techniques such as percutaneous thermal ablation (PTA) or arterial embolization have also been described as potential treatment alternatives in candidates deemed not fit for surgery. Systemic treatment has traditionally consisted of an anthracycline (doxorubicin)-based regimen with the addition of ifosfamide in certain cases. Recent advances in systemic treatment include the use of targeted therapy and immunotherapy in (oligo)-metastatic STS. However, except for certain histologies, most STS subtypes are chemoresistant, and the response to systemic treatment is poor.