Safety and efficacy of percutaneous image-guided ablation for soft tissue sarcoma metastases to the liver

PurposeTo evaluate outcomes following percutaneous image-guided ablation of soft tissue sarcoma metastases to the liver.Materials and MethodsA single-institution retrospective analysis of patients with a diagnosis of metastatic soft tissue sarcoma who underwent percutaneous image-guided ablation of hepatic metastases between January 2011 and December 2021 was performed. Patients with less than 60 days of follow-up after ablation were excluded. The primary outcome was local tumor progression-free survival (LPFS). Secondary outcomes included overall survival, liver-specific progression-free survival. and chemotherapy-free survival.ResultsFifty-five patients who underwent percutaneous ablation for 84 metastatic liver lesions were included. The most common histopathological subtypes were leiomyosarcoma (23/55), followed by gastrointestinal stromal tumor (22/55). The median treated liver lesions was 2 (range, 1-8), whereas the median size of metastases were 1.8 cm (0.3-8.7 cm). Complete response at 2 months was achieved in 90.5% of the treated lesions. LPFS was 83% at 1 year and 80% at 2 years. Liver-specific progression-free survival was 66% at 1 year and 40% at 2 years. The overall survival at 1 and 2 years was 98% and 94%. The chemotherapy-free holiday from the start of ablation was 71.2% at 12 months. The complication rate was 3.6% (2/55); one of the complications was Common Terminology Criteria for Adverse Events grade 3 or higher. LPFS subgroup analysis for leiomyosarcoma versus gastrointestinal stromal tumor suggests histology-agnostic outcomes (2 years, 89% vs 82%, p = .35).ConclusionPercutaneous image-guided liver ablation of soft tissue sarcoma metastases is safe and efficacious. Image-guided ablation of sarcoma metastasis is a promising modality for treating sarcoma metastases to the liver, with a local tumor progression-free survival of 83% and 80% at 1 and 2 years. Subgroup analysis demonstrated no significant differences between the local tumor progression-free survival of gastrointestinal stromal tumor versus leiomyosarcoma, suggesting a histology-agnostic treatment paradigm.