Between 1985 and 1993, six patients were surgically treated for
alveolar soft-part sarcoma (ASPS) arising from the thighs or buttocks, four of whom underwent aggressive excision of multiple
metastases using a
neodymium:
yttrium-aluminum garnet (
Nd:YAG) laser. In total, 333
tumors were removed from these four patients during eight pulmonary operations. In patients 1, 3, and 4, uncontrollable extrapulmonary involvement and/or local recurrence at the primary site were noted during their treatment course, and they died of
tumor progression 40, 68, and 46 months after excision of the primary lesion, respectively. In patient 1, a 37-year-old woman, prolonged survival with adequate lung function was achieved after the excision of
metastases, including one bulky metastatic
tumor located adjacent to the mediastinum, which might have led to a lethal complication. Patient 3, a 25-year-old woman who underwent aggressive
metastasectomies for both pulmonary and extrapulmonary
metastases combined with intermittent
chemotherapy, died of widespread
metastases to multiple organs. On the other hand, patient 2, a 23-year-old woman who underwent excision of 130 pulmonary and three
brain metastases during four
thoracotomies and two
craniotomies, is still alive without any symptoms 98 months after excision of the primary lesion. These data suggest that repeated excisions of lung
metastases from ASPS may influence long-term survival or maintenance of good performance status in patients in whom extrapulmonary
metastasis and recurrence are either absent or controlled.