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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2010.tde-22092010-114710
Document
Author
Full name
Rodrigo Afonso da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2010
Supervisor
Committee
Figueiredo, Luiz Francisco Poli de (President)
Fontes, Belchor
Leão, Luis Eduardo Villaça
Santim, Roberto Attilio Lima
Wolosker, Nelson
Title in Portuguese
Fatores prognósticos no tratamento cirúrgico de pacientes com metástases pulmonares de sarcoma de partes moles
Keywords in Portuguese
Metástase neoplásica
Neoplasias pulmonares
Prognóstico
Sarcoma de tecidos moles/cirurgia
Abstract in Portuguese
Metastases pulmonares isoladas de sarcomas de partes moles ocorrem em 20%-50% dos pacientes, e 70% destes pacientes apresentarão doença limitada aos pulmões. A ressecção cirúrgica é bem aceita como tratamento padrão nas metastases de sarcomas de partes moles confinadas aos pulmões, com muitos estudos relatando sobrevida em cinco anos de 305-40%, ssndo que o fator preditor de sobrevida é a ressecção completa. O objetivo deste estudo é determinar as variáveis clínicas e demográficas relacionadas ao tratamento e associadas com a sobrevida global a longo prazo (90 meses) nos pacientes submetidos a metastasectomia pulmonar de sarcomas de partes moles. Uma revisão retrospectiva foi realizada nos pacientes com metastases pulmonares que foram submetidos à toracotomia para ressecção das metástases, após o tratamento do tumor primário. Os dados foram coletados de acordo com as características do tumor primário, dados demográficos, tipo de tratamento e evolução. Pacientes (n=77) com sarcomas de partes moles previamente tratados foram submetidos a um total of 122 toracotomias e 273 nódulos ressecados. O seguimento mediando de todos os pacientes foi de 36.7 meses (variação: 10-138 meses). O índice de complicações pós-peratórias foi 9.1%, e a mortalidade em 30 dias de 0%. A sobrevida global em 90 meses para todos os pacientes foi de 34.7%. A análise multivariada identificou o número de metástases, o intervalo livre de doença, e ressecção completa, como fatores prognósticos independentes para a sobrevida global. Estes resultados confirmam que a metastasectomia pulmonar é um procedimento seguro e com potencial curativo para pacientes com tumors primários tratados. Um grupo seleto de pacientes pode apresentar uma sobrevida a longo prazo interessante após a ressecção pulmonar
Title in English
Pulmonary metastasectomy from soft tissue sarcomas: factors affecting survival
Keywords in English
Lung neoplasms
Neoplasm metastasis
Prognosis
Sarcoma/surgery
Abstract in English
Isolated pulmonary metastases from soft tissue sarcomas occur in 20%-50% of these patients, and 70% of these patients will have disease limited only to the lungs. Surgical resection is well accepted as a standard approach to treat metastases from soft tissue sarcomas isolated to the lungs, with many studies reporting overall 5-year survival ranging from 30% to 40%, and the most consistent predictor of survival in these patients is complete resection. The aim of this study is to determine demographics and clinical treatment-related variables associated with long-term (90-month) overall survival in patients with lung metastases undergoing pulmonary metastasectomy from soft tissue sarcomas. A retrospective review was performed of patients who were admitted with lung metastases and underwent thoracotomy for resection, after treatment of the primary tumor. Data were collected regarding primary tumor features, demographics, treatment, and outcome. Patients (n=77) with preview soft tissue sarcomas treated, were submitted to a total of 122 thoracotomies and 273 nodules resected. Median follow-up time of all patients was 36.7 months (range: 10-138 months). The postoperative complication rate was 9.1%, and the 30-day mortality rate was 0%. The 90-month overall survival rate for all patients was 34.7%. Multivariate analysis identified the number of metastases resected, disease-free interval, and complete resection as the independent prognostic factors for overall survival. These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after lung resection
 
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RodrigoAfonsoSilva.pdf (652.15 Kbytes)
Publishing Date
2010-09-23
 
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