Multimodality treatment including surgery for primary pulmonary sarcoma: size does matter

Background:

Primary pulmonary sarcoma is a rare malignancy accounting for less than 0.5% of all pulmonary tumors. Few outcome data are reported. The aim of this study is to evaluate outcome and prognostic factors in patients with primary pulmonary sarcoma that were surgically treated with a curative intent multimodality therapy concept.

Material and Methods:

We retrospectively reviewed all patients who underwent resection for primary pulmonary sarcoma in our center from 2002 to 2018. Survival was calculated from the date of surgery until last follow-up. The impact on survival of the following variables was assessed: gender, type of lung resection, completeness of resection, histology, tumor grade, tumor size, response to neoadjuvant therapy, TNM stages for soft tissue sarcoma and for non-small cell lung cancer.

Results:

Thirteen patients (7 females, 54%) with a median age of 56 (21 – 79) were included. Histology was synovial sarcoma (n = 4, 31%), pleomorphic sarcoma (n = 2, 15%), malignant schwannoma (n = 2, 15%), sarcoma not otherwise specified (n = 2, 15%), ewing sarcoma (n = 1, 8%), leiomyosarcoma (n = 1, 8%) and liposarcoma (n = 1, 8%). Eight (62%) patients received neoadjuvant treatment. Median tumor size at diagnosis was 11.5 cm (1 – 30 cm). Type of lung resection were atypical lung resection (n = 2, 15%), lobectomy (n = 4, 31%), intrapericardial pneumonectomy (n = 3, 23%) and extrapleural pneumonectomy (n = 4, 31%). Minor postoperative complications occurred in eight patients (62%). In-hospital mortality was 8%. Overall 5-year survival was 60%. Median follow up was 46 months. Median disease-free survival was 17 months. Cox regression analysis identified tumor size as a predictor for survival (p = 0.023) and recurrence (p = 0.050). Univariate analysis identified gender (p = 0.004) and type of lung resection (p = 0.004) as predictor of survival while TNM stage for soft tissue sarcoma was a predictor for recurrence (p = 0.025).

Conclusion:

Surgical resection within a multimodality therapy concept in highly selected patients with primary pulmonary sarcoma can offer good long-term outcome.