Because sarcoma preferentially spread to the lungs, surgical resection of lung metastases can be curative or significant extend life (years) for sarcoma patients. The most common options facing patients are VATS, open thoracotomy (surgical wedge resection), and radiofrequency ablation. The gold standard is open thoracotomy in terms of try to remove all gross disease. If resections are complete, there is the possibility of long term (decades) remission or "NED" (no evidence of disease). But there are significant risks and irreversible consequences of conventional thoracotomy, and in addition, many more patients will be told they are not operative candidates at all because there are too many lung nodules, there are central lung nodules (deep in the lung lobe) and / or they involve all lobes.We wanted to post about the option for laser resection of sarcoma lung metastases because this approach offers hope to patients who are thought to be unresectable by conventional surgery, and less disabling surgery for those who are contemplating conventional thoracotomy.
The lung metastases in sarcoma are a common cause of death. Death can be caused by a number of factors -but most often due to cumulative tumor burden on the lungs, or compression of main airways or bronchi, or less commonly invasion of the heart or great vessels. The clinical rationale for removing lung metastases is not only the removal of tumors that may invade critical structures, but also there seems to be a therapeutic effect of thoracotomy on sarcomas that might be an immune response to the actual surgery itself.
The survival statistics for redo thoracotomy are pretty impressive (see below), although a surgeon friend of our said to be wary of "sampling error" - the more healthy people may be candidates for redo thoracotomy.
See entire Powerpoint presentation here. There are many other supporting studies that support repeated resection or metastasectomy when the primary soft tissue sarcoma is removed and the lungs are the only known site of metastases, but for instance in our daughter's rare alveolar soft part sarcoma, Judson's group reported that of 9 patients who underwent metastectomy, 7 achieved complete clearance and 44% were disease-free at last following (followup ranging from 2-22 years).
The purpose of this blog is to share what information and experience we have gained in our daughter's battle with metastatic sarcoma. Patients and their families should research promising therapies and investigational drugs because great progress is being made into the biology of these rare cancers and no single doctor will be able to keep up with all the research advances.
Recently we have been contacted by numbers of patients seeking more information about our experiences with laser resection in Germany with Dr. Rolle. In order to make it easier for others to learn from our personal experiences and sharing of the literature, we decided to post the information to a blog. We realize this may be a big step for you to take, and if you have any questions, please feel and contact by email or through the comments on this blog.
