Ablative Techniques for Sarcoma Metastatic Disease: Current Role and Clinical Applications

Abstract

Sarcomas are heterogenous mesenchymal neoplasms with more than 80 different histologic subtypes. Lung followed by liver and bone are the most common sites of sarcoma metastatic disease. Ablative techniques have been recently added as an additional alternative curative or palliative therapeutic tool in sarcoma metastatic disease. When compared to surgery, ablative techniques are less invasive therapies which can be performed even in non-surgical candidates and are related to decreased recovery time as well as preservation of the treated organ's long-term function. Literature data upon ablative techniques for sarcoma metastatic disease are quite heterogeneous and variable regarding the size and the number of the treated lesions and the different histologic subtypes of the original soft tissue or bone sarcoma. The present study focuses upon the current role of minimal invasive thermal ablative techniques for the management of metastatic sarcoma disease. The purpose of this review is to present the current minimally invasive ablative techniques in the treatment of metastatic soft tissue and bone sarcoma, including local control and survival rates.

Keywords: ablation; oligometastatic; sarcoma.

Figure 1

(A) 59 years-old female sarcoma patient with a solitary metastasis of the left lung; (B) CT-guided microwave ablation was performed; (C) Metastasis was completely ablated with safety margins (ground glass infiltrate).

Figure 2

(A) A 64 years-old male leiomyosarcoma patient with a solitary hepatic metastasis (white arrow); (B) CT-guided microwave ablation was performed; (C) Post ablation CT scan, coronal reconstruction (portal venous phase) illustrates the zone of necrosis (white arrow).

Figure 3

(A) CT axial scan illustrating a lytic thoracic wall metastasis in a 46 years-old male hemangiopericytoma patient; (B) CT-guided cryoablation was performed for pain palliation; (C) Post ablation CT axial scan illustrates the ice ball covering the whole lesion and safety margins.