Cure Alveolar Soft Part Sarcoma International (iCureASPS)

Abstract

Bone and soft tissue malignancies account for a small portion of brain metastases. In this review, we characterize their incidence, treatments, and prognosis. Most of the data in the literature is based on case reports and small case series. Less than 5% of brain metastases are from bone and soft tissue sarcomas, occurring most commonly in Ewing’s sarcoma, malignant fibrous tumors, and osteosarcoma. Mean interval from initial cancer diagnosis to brain metastasis is in the range of 20–30 months, with most being detected before 24 months (osteosarcoma, Ewing sarcoma, chordoma, angiosarcoma, and rhabdomyosarcoma), some at 24–36 months (malignant fibrous tumors, malignant peripheral nerve sheath tumors, and alveolar soft part sarcoma), and a few after 36 months (chondrosarcoma and liposarcoma). Overall mean survival ranges between 7 and 16 months, with the majority surviving < 12 months (Ewing’s sarcoma, liposarcoma, malignant fibrous tumors, malignant peripheral nerve sheath tumors, angiosarcoma and chordomas). Management is heterogeneous involving surgery, radiosurgery, radiotherapy, and chemotherapy. While a survival advantage may exist for those given aggressive treatment involving surgical resection, such patients tended to have a favorable preoperative performance status and minimal systemic disease.


https://www.hindawi.com/journals/sarcoma/2014/475175/

3.2.5. Alveolar Soft Part Sarcoma

Alveolar soft part sarcomas (ASPS) account for a small percentage of STS at roughly 1% [88, 89]. In contrast to bone-part tumors, ASPS is a soft-part tumor that presents mainly in muscle and deep soft tissue of the thigh or leg [130–133]. A malignancy found in younger patients, those diagnosed are mostly below the age of 40 years [130, 131, 133, 134]. While it metastasizes to lung and bone, unlike other sarcomas, it has a predisposition towards BM with estimates of 15 to 30% in those with stage IV disease [1, 135]. On the other hand, ASPS patients have been reported to have greater oncological control with better relapse-free survival [1]; even though 25% of patients have metastasis at presentation, overall survival is comparatively high at 10–12 years [136, 137].

Portera et al. [134] studied a large cohort of 74 patients with ASPS. The majority (65%) presented with Stage IV disease and BM (19%) was only present in those with other metastases, particularly lung. Eight (88.9%) of the 9 patients with BM developed neurological symptoms, and imaging performed in those without such symptoms did not reveal occult BM. Resistance to conventional chemotherapy was noted and overall survival was 40 months. Daigeler et al. [130] described similar result in their small series and recommended SR followed by RT for both the primary and resectable metastases and found tumor size at presentation to not influence long-term results.

The literature is abundant with reports of BM from ASPS. Table 7 presents a summary of cases from published series [2, 4, 5, 15, 38, 130, 134, 138, 139]. The IB ranged from 1 to 156 months, roughly averaging 29 months. Patient’s age was approximately 30 years, without a remarkable predilection to any one of the sexes. OS ranged significantly (1–36 years), with a mean between 3 and 4 years [130]. Five-year survival reportedly ranges between 59 and 67% [133]. Long-term survivors have been known to exhibit spontaneous regression phenomenon, in which there is partial or complete disappearance of the malignancy in absence of traditional treatment [131].

tab7
Table 7: Summary of cases of alveolar soft part sarcoma with brain metastases as reported in previous published series.
Neurosurgical resection can be favorable and may increase long-term survival [1, 132, 133, 135]. A surgical advantage may exist with ASPS when compared to other sarcomas. There is little evidence to support routine brain imaging without metastatic disease at other sites. Chemotherapy has not been found to be helpful, as there is frequently lack of response. Even though ASPS has a larger predisposition for BM, patients with ASPS BM generally have a better prognosis than other bone and soft tissue malignancies [1].