Brain metastasis in bone and soft tissue cancers: a review of incidence, interventions, and outcomes
Faris Shweikeh1, Laura Bukavina2, Kashif Saeed3
1College of Medicine, Northeast Ohio Medical University, 4209 State Route 44, Rootstown, OH 44272, USA.
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.
Insights
Brain metastases from bone and soft tissue sarcomas are rare, typically occurring within 2-3 years of initial diagnosis. Survival is generally less than 12 months, though aggressive treatment may improve outcomes.
Area of Science:
- Oncology
- Neurology
- Pathology
Background:
- Brain metastases from bone and soft tissue sarcomas are uncommon, representing less than 5% of all brain metastases.
- Existing literature primarily consists of case reports and small case series, limiting comprehensive understanding.
Purpose of the Study:
- To review the incidence, treatment, and prognosis of brain metastases originating from bone and soft tissue malignancies.
- To analyze the time intervals to brain metastasis detection and overall survival rates for various sarcoma subtypes.
Main Methods:
- Systematic literature review of case reports and case series focusing on bone and soft tissue sarcomas with brain metastases.
- Analysis of reported data on incidence, time to metastasis, treatment modalities, and survival outcomes.
Main Results:
- Ewing's sarcoma, malignant fibrous tumors, and osteosarcoma are the most common primary sites for brain metastases.
- The mean interval from diagnosis to brain metastasis ranges from 20-30 months, with most detected within 24 months.
- Overall mean survival is typically 7-16 months, with most patients surviving less than 12 months.
Conclusions:
- Brain metastases from bone and soft tissue sarcomas have a poor prognosis, with limited survival.
- Aggressive multimodal treatment, including surgery, may offer survival benefits, particularly in patients with good performance status and limited systemic disease.
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