Purpose: Brain metastases (BM) in sarcomas occur rarely and are associated with poor prognosis. This study is a large retrospective cohort describing the demographic and clinical characteristics of these patients, treatment strategies, and survival outcomes. Methods: In total, 81 patients with BM from sarcomas were identified across five sarcoma centers. Demographic data, clinical presentation, and treatment modalities were analyzed. Results: The most common histologies were leiomyosarcoma (12.3%) and undifferentiated pleomorphic sarcoma (12.3%). The median time from sarcoma diagnosis to brain metastases was 1.9 years. Upon presentation, 88.9% of patients with BM from sarcomas were symptomatic with the most common presenting symptom being focal neurological deficits (37.9%) and headaches (22.1%). Higher-grade sarcomas were more likely to metastasize and were usually preceded by metastases to other sites, most commonly the lungs. One-year overall survival was 31% from initial sarcoma diagnosis, and the median time from diagnosis of BM until death was 6.0 months. For treatment, 60 (74.1%) patients had radiation, 39 (48.1%) patients had systemic therapy, and 29 (35.8%) patients had surgery. In a multivariate analysis, surgery (HR 0.30) and chemotherapy (HR 0.23) were found to be significantly correlated with improved survival outcomes. Although radiation as a whole was not found to significantly correlate with survival, improved outcomes were seen with stereotactic radiosurgery (SRS, mOS 11.6 mo) as opposed to whole-brain radiation therapy (WBRT, mOS 8.3 mo). Additionally, patients with leptomeningeal disease were significantly less likely to survive more than one year compared to patients with brain metastases only. Conclusions: Our findings identify that patients with metastatic sarcoma to the brain have poor prognoses, often have concurrent metastasis, and have a median survival of only 6 months. Additionally, our study found that leptomeningeal metastases is a rare presentation with poor survival outcomes. There are various treatment modalities for sarcomas with BM; however, there are no guidelines, unlike in other malignancies. Further research is necessary to evaluate the role of therapeutic measures in terms of type, timing, and outcomes.
目的：肉瘤的脑转移（BM）较为罕见且预后不良。本研究通过大型回顾性队列，描述了此类患者的人口统计学与临床特征、治疗策略及生存结局。方法：从五个肉瘤中心共纳入81例肉瘤来源的脑转移患者。对其人口统计学资料、临床表现及治疗方式进行分析。结果：最常见的组织学类型为平滑肌肉瘤（12.3%）和未分化多形性肉瘤（12.3%）。从肉瘤确诊到发生脑转移的中位时间为1.9年。就诊时，88.9%的肉瘤脑转移患者出现症状，最常见的表现为局灶性神经功能缺损（37.9%）和头痛（22.1%）。高级别肉瘤更易发生转移，且通常先转移至其他部位（最常见为肺部）。自肉瘤初次诊断起的一年总生存率为31%，从脑转移确诊至死亡的中位时间为6.0个月。治疗方面，60例（74.1%）患者接受放疗，39例（48.1%）接受全身治疗，29例（35.8%）接受手术治疗。多变量分析显示，手术（风险比0.30）与化疗（风险比0.23）与生存改善显著相关。虽然放疗整体与生存率无显著相关性，但立体定向放射外科（SRS，中位生存期11.6个月）较全脑放疗（WBRT，中位生存期8.3个月）显示出更好的疗效。此外，与单纯脑转移患者相比，软脑膜转移患者的1年生存率显著降低。结论：本研究发现肉瘤脑转移患者预后较差，常伴有其他部位转移，中位生存期仅为6个月。同时，软脑膜转移虽属罕见但生存结局极差。目前针对肉瘤脑转移存在多种治疗方式，但与其他恶性肿瘤不同，尚缺乏规范的治疗指南。未来需进一步研究以评估不同治疗措施在类型、时机及疗效方面的作用。
Brain Metastases in Sarcomas: A Multicenter Retrospective Cohort Study
肿瘤(癌症)患者之家