Circulating tumor cells in sarcomas: a brief review

Although rare, sarcomas represent a source of significant morbidity and mortality with nearly one reported death for every two new diagnoses. The detection and surveillance of circulating tumor cells (or CTCs) has been found to have significant clinical utility in epithelial malignancies, such as carcinoma of the colon, breast and prostate. Here, we summarize what is known regarding CTCs in sarcomas. Although still in its relative infancy, the detection of CTCs in sarcoma patients may help to diagnose and predict recurrence or metastasis as well as improve the overall management of sarcoma patients. CTCs are most often detected via reverse transcriptase polymerase chain reaction or antibody-based detection of cell surface proteins, including flow cytometry. Samples may be obtained from either peripheral blood or bone marrow. CTC detection in translocation sarcomas is perhaps most promising, as a recurrent abnormal gene fusion product can be detected in involved individuals but not in the normal patient. Studies in Ewing's sarcoma/peripheral neuroectodermal tumor, synovial sarcoma and alveolar soft part sarcoma have confirmed the feasibility of this approach. Other investigators have turned toward detection of more universal markers of sarcomas, such as the pan-mesenchymal marker Vimentin. In the case of osteosarcoma, more specific markers of osteogenic differentiation (Type I Collagen) have been utilized. In summary, although in its relative nascency, the use of CTC detection for the management of sarcoma patients shows initial promise.