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J Thorac Cardiovasc Surg 1998;115:671-680
© 1998 Mosby, Inc.

GENERAL THORACIC SURGERY

Primary Sarcomas Of The Mediastinum: Results Of Therapy

Michael Burt, MD, PhD^a, Janet K. Ihde, MD^a*, Steven I. Hajdu, MD^b, James W. Smith, MD^a**, Manjit S. Bains, MD^a, Robert Downey, MD^a, Nael Martini, MD^a, Valerie W. Rusch, MD^a, Robert J. Ginsberg, MD^a

From The Thoracic Service, Department of Surgery^a and the Pathology Department,^b Memorial Sloan-Kettering Cancer Center, New York, N.Y.

Received for publication March 17, 1997; revisions requested July 15, 1997; revisions received Sept. 26, 1997; accepted for publication Sept. 29, 1997. Address for reprints: Robert J. Ginsberg, MD, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021.

Primary sarcomas of the mediastinum are rare, and data concerning treatment and results of therapy are sparse.
Objective: To assess presentation, management, prognostic factors, and survival in mediastinal sarcomas.
Methods: We reviewed our experience with 47 patients with the diagnosis of primary sarcoma of the mediastinum. Data were collected from a computerized institutional database and medical records. Survival was analyzed by Kaplan-Meier method and comparisons of survival by log rank test.
Results: The median age of 47 patients with mediastinal sarcoma was 39 years (range 2.5 to 69 years), with a male/female ratio of 1.6. The most common complaints were chest/shoulder pain (38%) and dyspnea (23%). The most common tumor types were malignant peripheral nerve tumor (26%), spindle cell sarcoma (15%), leiomyosarcoma (9%), and liposarcoma (9%). Operation was the primary treatment modality in 72% of cases (n = 34); 22 sarcomas (47%) were completely resected. The overall 5-year survival was 32%. High-grade lesions had a significantly decreased survival (5-year survival = 27%) compared with low-grade tumors (5-year survival = 66%) (p = 0.05). The overwhelming factor determining survival was the ability to completely resect the tumors (5-year survival 49% for complete resection; 3-year survival 18% for incomplete or no resection) (p = 0.0016). Despite complete resection, local recurrence occurred in 64% of cases.
Conclusion: Because the overall survival for patients with mediastinal sarcomas is 32% and the local recurrence is 64% for tumors completely resected, aggressive adjuvant therapy should continue to be systematically explored.

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