Surgery of Sarcoma Metastases

Speaker: Peter Hohenberger

Although drug therapy resulted in considerable advances in the treatment of metastatic soft tissue sarcomas (STS), Peter Hohenberger points out that the interaction between systemic therapies and local measures and patients’ selection, are playing an important role. 

In addition to surgical resection, radio-frequency ablation, irreversible electroporation or stereotactic radiation therapy... are techniques that may be used to destroy metastasis.

Selecting the patients who can really benefit from such local treatment from those where it is feasible is extremely important. Re-adopting the concept of oligometastatic disease could be a good way to select patient.

For sarcoma in general, there is no evidence that surgically removing the metastasis results in a better prognosis for overall survival. However, in some selected STS patients after detection of the metastasis, surgical removal significantly improves survival. These observations haven't been adopted into a guideline yet but factors such as the interval before the appearance of the first metastasis should be considered.

Questions

  • Evidence for practice and outcomes
  • Techniques evolution
  • Importance of the surgical margin
  • Role of histology in stratification