“Local Ablative Therapies to Metastatic Soft Tissue Sarcoma”
ABSTRACT
The approach to metastatic soft tissue sarcoma is complex and depends upon several factors, such as the extent of the disease, the histologic subtype of the primary tumor, the disease-free interval, patient status and comorbidities, and previous treatments. The effect of systemic chemotherapy is suboptimal, therefore local ablative therapies are often considered when the disease is limited, especially if confined to a single site/organ. Historically, surgery has been considered the treatment of choice for isolated lung metastases. This approach also has been extended to metastases in the liver, although a formal demonstration of its benefit has never been provided. Radiation therapy instead has been mainly used to obtain pain control and to reduce the risk of bone fracture and cord compression. Advances in techniques, such as the development of more precise conformational modalities and the employment of particles, may change the role of this modality in the strategic approach to metastatic soft tissue sarcoma. Recently, the use of interventional radiology in this scenario has expanded.
Ablative approaches, such as radiofrequency ablation and cryoablation, have shown durable eradication of tumors. Catheter-directed therapies, such as hepatic artery embolization, are potential techniques for treating the patient who has multiple unresectable liver metastases.
Understanding the timing and role of these three different modalities in the multidisciplinary approach to metastatic soft tissue sarcoma is critical to provide better care and to personalize the approach to the single patient.
KEY POINTS
The initial metastatic spread of soft tissue sarcoma is often confined to a single organ (predominantly the lung, but also the liver and soft tissues), making the use of locoregional therapies attractive.
Surgery may be the treatment of choice or may complement systemic therapy in patients affected by isolated oligometastatic disease with favorable prognostic factors (long disease-free interval, limited disease, site of metastasis).
Radiation therapy can be an effective palliative intervention in metastatic sarcoma. More research is warranted into whether highly conformal, ablative radiation therapy can prolong disease-specific survival in select patients with metastatic sarcoma.
Interventional radiology therapies like ablation play a role to control oligometastatic disease in patients with sarcoma who cannot tolerate surgery.
Liver-directed interventional radiology therapies, like hepatic artery embolization, chemoembolization, and radioembolization, may prolong life in patients with liver-dominant metastatic disease.
https://ascopubs.org/doi/full/10.1200/EDBK_157450