Surgical treatment for primary chest wall sarcoma: a single-institution study

Background:

Primary chest wall sarcomas are rare aggressive malignancies. Surgery represents the mainstay of treatment. The aim of this study is to examine our institutional experience and evaluate factors predicting outcome after resection of primary chest wall sarcoma.

Material and Methods:

We retrospectively reviewed data from all patients who underwent surgery in a curative intent for primary chest wall sarcoma in our center from 2005 to 2018. Survival was calculated from the date of surgery until last follow- up. Univariate analysis was performed to study the impact on overall survival (OS) and disease-free survival (DFS) of the following variables: age, gender, presence of preoperative histological diagnosis, tumor size and grade, completeness of resection, presence of neoadjuvant and adjuvant therapy.

Results:

Twenty-two patients (13 males, 59%) with a median age of 52 (4 to 82) were included. Histology was Ewing sarcoma/primitive neuroectodermal tumor (n = 4, 18%), liposarcoma (n = 4, 18%), chondrosarcoma (n = 3, 13%), osteosarcoma (n = 3, 13%), pleomorphic sarcoma (n = 2, 9%), malignant peripheral nerve sheath tumor (n = 2, 9%), fibrosarcoma (n = 1, 5%), malignant fibrous histiocytoma (n = 1, 5%), triton tumor (n = 1, 5%), fibromyxoid sarcoma (n = 1, 5%). Eight patients (36%) received neoadjuvant treatment and 12 patients (55%) received adjuvant therapy. Median tumor size at diagnosis was 95 mm (20 to 240). Sarcomas were resected en-bloc. Complete resection rate (R0) was 76%. Chest wall reconstruction was required in 12 patients (55%). Postoperative complications occurred in 6 patients (27%). In-hospital and 90- day mortalities were 0%. Three- and 5-year OS were 49% and 39%, respectively. Median follow up was 19 months. Patients with R0 resection had a significantly better OS compared to those with incomplete resection (p = 0.007) and a trend for longer DFS (p = 0.134). Patients with higher tumor grades (G2-G3 vs. G1) had significantly worse DFS (p = 0.016) as well as a trend for lower OS (p = 0.097).

Conclusion:

Surgical resection of primary chest wall sarcoma is a safe procedure in experienced hands. Patient selection should focus on preoperative evaluation of resectability.