Long-Term Pulmonary Function after Metastasectomy for Childhood Osteosarcoma: A Report from the St Jude Lifetime Cohort Study

Abstract

Background Complete resection of lung metastases improves survival in patients with osteosarcoma. We evaluated the long-term effect of metastasectomy on pulmonary function of patients treated for osteosarcoma during childhood. Methods We reviewed the medical records of patients who had pulmonary function tests (PFTs) following metastasectomy for osteosarcoma. Patient, tumor, and treatment variables were abstracted along with PFTs. PFTs were recorded as a percentage of predicted value and were classified as abnormal for FVC <80%, FEV1 <80%, TLC <75%, and DLCOcorr <75%. Results Twenty-one patients had PFTs performed during follow-up. Mean age at diagnosis of osteosarcoma was 13.2±4.7 years. Fifteen patients had a single thoracotomy, and 6 patients had ≥ 2 thoracotomies (range, 2–6). Eighty lesions were resected. Nine patients had ≤ 2 lesions resected and 12 patients had >2 lesions (range, 3–12) resected. Mean time from the last surgical procedure to measurement of PFTs was 20.3±9.0years. TLC was abnormal for 28.6%, DLCOcorr for 47.4%, FVC for 40%, and FEV1 for 47.6% of the cohort members. Individual PFTs were abnormal in 13.3% (TLC) to 46.7% (DLCOcorr) of patients who had one thoracotomy and in 50.0% (DLCOcorr) to 66.7% (FEV1, TLC) of patients with ≥two thoracotomies. The number of thoracotomies was associated with abnormal TLC (p=0.03). Discussion Patients who underwent pulmonary metastasectomy for osteosarcoma as children often had abnormal PFTs on long-term follow up, but the reduction in lung volumes and DLCOcorr was relatively mild. Multiple thoracotomies predicted greater impairment of pulmonary function.

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Metastasectomy in pediatric patients: indications, technical tips and outcomes

“…left in place after the patient is discharged, and then checked and removed when possible in an outpatient setting. After pulmonary metastasectomy for cancer, Pulmonary function can be impaired in patients in treatment and also in adult survivors (28,29), who often present restrictive syndrome and decreased physical function.…”