The surgeon will see you now: selecting soft-tissue sarcoma patients for pulmonary metastasectomy

Soft-tissue sarcoma (STS) is a heterogeneous disease comprised by a number of histologic subtypes. Patterns of metastases, however, are common amongst these tumors. In particular, the lung is the primary site of metastases in STS and pulmonary metastases develop in up to 50% of STS patients (1-4). In the relative absence of effective systemic therapy, metastatic STS presents significant challenges in oncology, and pulmonary metastasectomy (PM) has become a common therapeutic modality for patients with metastatic pulmonary disease (3,5). The data underlying the rationale for PM for STS, however, are comprised predominantly by low level evidence, and it has been argued that the favorable outcomes of PM studies are resultant from selection biases towards tumors with favorable tumor biology. Whereas to some extent this may be true, an opposing argument supports the viewpoint that a thorough understanding of patient characteristics associated with favorable clinical outcomes could be utilized to intentionally select individuals in whom PM is beneficial. Such data would be clinically useful and could contribute to a decision-making framework for patients with STS.