Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma

Ann Surg. 1993 Dec;218(6):705-12. doi: 10.1097/00000658-199312000-00002.


Objective: The authors reviewed a series of adult patients with extremity soft tissue sarcoma to determine the incidence of pulmonary metastases and outcome after treatment.

Methods: Of 716 patients admitted between January 1983 and December 1990, 135 (19%) had isolated pulmonary metastases as the initial site of distant recurrence. Fifty-eight percent (78 of 135) of the patients were treated surgically, and 83% of them had their tumors completely resected.

Results: The median survival after complete resection was 19 months; incomplete resection, 10 months; and no operation, 8 months (p = 0.005). The 3-year survival rate after complete resection was 23%, compared with a 2% rate (1 of 57) in those treated nonsurgically (p < 0.001). Factors associated with an increased risk of pulmonary metastases included high tumor grade, tumor size greater than 5 cm, lower extremity site, and histologic type (spindle cell, tendosynovial, and extraskeletal osteosarcoma). Factors associated with complete resectability were the histologic types of spindle cell and extraskeletal osteosarcoma.

Conclusions: Complete surgical resection remains the only possibility for cure from pulmonary metastases in soft tissue sarcoma; however, only 11% of the 19% of patients with an extremity sarcoma whose first distant recurrence is in the lung will be alive at 3 years, despite therapy. Complete resection and the development of more effective adjuvant treatments are imperative to improve outcome for this group of patients.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Extremities*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Pneumonectomy*
  • Prospective Studies
  • Sarcoma / epidemiology
  • Sarcoma / secondary*
  • Sarcoma / surgery*
  • Soft Tissue Neoplasms / pathology*
  • Survival Rate