Treatment of Primary and Metastatic Sarcoma

At the Society of Interventional Oncology (SIO) Annual Scientific Meeting, Jack Jennings, MD, PhD, Washington University in St Louis, Missouri, discussed the role of the interventional oncologist when treating primary or metastatic sarcomas of the bone or soft tissue.

In primary sarcomas, Dr Jennings noted the main role would be in biopsy for diagnosis and staging or molecular analysis. For metastatic sarcomas, treatment can be provided for pain palliation or local tumor control. Dr Jennings also highlighted the importance of interventional oncologists being on multidisciplinary tumor boards and in the clinics.

Transcript:

Welcome. My name is Jack Jennings and I'm a musculoskeletal radiologist at Washington University. I predominantly do interventional oncology. I was asked to talk about a topic that was presented by myself at the most recent SIO 2024 in Long Beach, California, which for the record was the most attended SIO meeting in the history of the WCIO/SIO. I was asked to talk about treatment of primary and metastatic bone and soft tissue sarcomas and what the role of the interventional oncologist is.

When it comes to primary sarcomas our role is basically biopsy. That's the key role with us: biopsy, diagnosis and staging, biopsy for molecular analysis. Regarding interventions such as thermal ablation and/or embolization, typically when it's a primary bone or soft tissue, they are surgically resected. In my career, I have done a few cases where that was not done for certain reasons. But that's not the standard practice, or standard of care. And surely not in the NCCN guidelines.

There's over 100 sarcomas. Interventional oncology plays a key role in the multidisciplinary treatment of these. Local therapies and sarcomas go hand in hand because often systemic or immunotherapies can work and then don't work, and they get down to third and fourth line. When it comes to metastatic sarcomas, interventional radiology is on the map. It's on the NCCN guidelines. If you look at the NCCN guidelines for sarcoma, you will find interventional procedures on their ablation, embolization for treatment of both diffusely metastatic and oligometastatic sarcomas. And there have been some trials showing that increase in progression-free survival of treatment of patients who are oligometastatic. The key to this is us as interventionalists being at the table, meaning being at the multidisciplinary tumor boards, educating our oncologists, radiation oncologists and surgical oncologists. And just as important, having an active clinic where we can see these patients, educate them about our therapies and what we can offer, and that they're minimally invasive.

When it comes to metastatic disease, we could do it for pain palliation or for local tumor control. Typically, those for local tumor control are oligometastatic, and there we need to get margins and treat aggressively. However, I would argue that even for palliative procedures, the better local control you get, the more durable pain palliation you'll achieve, right? If you can get margins around this lesion and control it, then it’s less likely for it to recur or increase in size and cause pain. In ASCO back in 2018 or 2019, as far as the multidisciplinary management of oligometastatic disease of sarcoma, interventional radiology is listed in there. And now, when you go to the 2023 NCCN guidelines for sarcoma, you'll see a whole section on interventional oncology and what interventional oncology can offer. This was done by Lindsay Stratchko, [DO, University of Wisconsin School of Medicine and Public Health]  and it's a really a great synopsis of what we can offer.

In summary, interventional oncology/radiology is very much at the table for the multidisciplinary treatment of soft tissue and osteo metastatic sarcomas. And often single-line therapies are not successful. Local therapies are a big part of sarcoma treatment. When it's for oligometastatic disease, the goal is for local tumor control to increase progression-free rates and progression-free survivals, and ultimately overall survival. And we've shown that ablation is safe for all these.

Thank you very much for this invitation, and, uh, look forward to seeing you at the SSIO 2025 in Las Vegas.

Source:

Jennings J. “Treatment of Primary or Metastatic Sarcoma.” Presented at the SIO 2024 Annual Scientific Meeting; January 25-29, 2024; Los Angeles, California.