Lung metastases from sarcoma: multidisciplinary approach -a narrative review

Objective: This is a narrative review on the state of the art of multidisciplinary treatment of metastatic sarcomas. We aim to report and analyze indications to chemo-radio and surgical treatment currently suggested by the results of principal studies reported in the literature. Background: Pulmonary metastases are a sign of advanced disease and are always a challenge in the management of oncologic patients. The mainstay of treatment is the surgical resection of all metastatic nodules which offers a potentially curative option and a significant survival advantage. In the setting of metastatic sarcoma, lung involvement is frequent, and the disease tends to recur with a significantly higher pattern than in any other tumor type. Multiple or even extended operations are often necessary. Alongside the operative approach, medical therapy has been reported with variable results. Currently, single -agent chemotherapy or combinations are reserved for patients with chemosensitive histology or patients considered for multimodality therapy. The role of immunotherapy, instead, despite promising results, is still under investigation. Radiotherapy has been boosted in recent years, with the spread of Stereotactic Body Radiation Therapy which overwhelmed the traditional sarcomas' radioresistance. Methods: A narrative review was conducted resulting from an analysis of the literature limited to peerreviewed studies on PubMed databases through May 31st, 2021. Original articles, reviews, meta -analysis, and case series were considered in which the main topic was pulmonary metastasectomy (PM), pulmonary sarcoma metastases, and metastatic sarcoma treatments. Studies were analyzed and synthetized highlighting their clinical relevance. Conclusions: Metastatic sarcoma is a complex and challenging disease to treat with gratifying results. PM is the cornerstone of treatment. Nevertheless, surgical resection is not enough, given the extreme variability of tumor types and the consequent biological behaviors. Tailored chemotherapy and radiotherapy protocols must be applied together with surgery because all modalities lack effectiveness when used alone. A multidisciplinary approach involving oncologists, radiotherapists, and surgeons is mandatory to better assess the timeline and the sequence in which every treatment gains better results, thus offering significant benefits for every patient.