Feasibility and Tolerability of Arterial Infusion Chemotherapy and Embolization for Recurrent/Metastatic Soft Tissue Sarcoma: A Retrospective Exploratory Study.
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OBJECTIVE: This study aimed to evaluate the feasibility and tolerability of arterial infusion chemotherapy embolization (AICE) in treating recurrent/metastatic soft tissue sarcoma (STS) and to explore relevant prognostic factors to tailor future individualized treatment. METHODS: A total of 113 patients with recurrent/metastatic STS treated with AICE at the Fifth Medical Center of the PLA General Hospital were included in this retrospective study. The primary outcomes were progression-free survival (PFS) and overall survival (OS). Kaplan-Meier survival curves were adopted and univariate and multivariate analyses were conducted using the Cox proportional hazards model to evaluate prognostic factors. Treatment-related adverse events (TRAEs) were graded according to the Society of Interventional Radiology (SIR) standards. RESULTS: Among the 113 patients, the median OS was 19.0 months (95% CI: 12.8-25.3) with 2-year OS rates of 45.1%. The median PFS was 11.0 months (95% CI: 8.6-13.4) with 2-year PFS rates of 25.7%. Objective response rate (ORR) was 37.2% (95% CI: 28.3%-46.8%) and disease control rate (DCR) was 76.1% (95% CI: 67.1%-83.6%). Univariate analysis revealed that tumor size, presence of distant metastasis, number of postoperative treatment regimens, pathological differentiation and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with OS and PFS (P<0.05). Multivariate Cox analysis confirmed that tumor size, distant metastasis, number of postoperative treatment regimens, pathological differentiation and short-term efficacy were independent prognostic factors for OS (P<0.05). The most common TRAEs were pain (23.0%), transient bone marrow suppression (15.0%) and postoperative fever (6.2%). No severe or fatal adverse reactions and treatment-related mortalities were observed, demonstrating superior tolerability. CONCLUSION: AICE might be a feasible and well-tolerated treatment for recurrent/metastatic STS, effectively controlling disease progression and improving survival outcomes in this retrospective cohort. Further multicenter, large-scale prospective studies were needed to validate these findings and explore the combination of AICE with immunotherapy or targeted therapy to optimize treatment strategy for STS.