Pulmonary metastases of stage IIB extremity osteosarcoma and subsequent pulmonary metastases.

Abstract

Intensive preoperative and postoperative chemotherapy combined with complete resection of both primary and metastatic pulmonary osteosarcomas is justified, with a goal of 100% tumor necrosis and excision. Although current treatment regimens allow effective salvage therapy for a few patients with pulmonary metastases, more effective systemic treatment is needed.

Treatment and outcome of recurrent osteosarcoma: Experience at Rizzoli in 235 patients initially treated with neoadjuvant chemotherapy

“…The pattern of relapse observed in our study was similar to that reported in previous studies [18,19,21,23]. Also the reduction in the number of pulmonary nodules at the initial disease recurrence reported in other studies [21,24,25] for patients treated with adjuvant or neoadjuvant chemotherapy in comparison with patients treated in the historical series only by surgery of the primary tumor was confirmed by our study.…”

Pattern of disease recurrence and prognostic factors in patients with osteosarcoma treated with contemporary chemotherapy

“…10 -13,15,17,21,24 Saeter et al reported an improved survival associated with an RFI longer than 21 months with univariate analysis, which lost significance in a multivariate analysis controlling for complete excision, solitary metastasis, and "adequate salvage chemotherapy" (p. 1090). 19 Bilateral pulmonary nodules have been associated with inferior survival in one report, 16 but not in others. 9,11,12,26 Improved survival has been associated with fewer pulmonary nodules, defined as 1, 19 1-2, 26 or 1-3, 9,16,25 but not in some series.…”

“…Tabone et al 15 reported that only one of seven patients with distant bone recurrence survived disease free with short-term follow-up. Ward et al 16 reported a 4-year postrecurrence survival rate of 0% n 17 patients with distant bone recurrence. Ferrari et al 20 reported no surviving patients among four patients with bone recurrence.…”

“…8,9,11,13,19,20,25,26 Goorin et al 12 reported a survival rate of 32% (7 of 22 patients) among patients with unresectable recurrent OS, although the duration of follow-up was not reported. Improved survival has also been associated with prolonged RFI, variably de- fined as longer than 6 months, 9 longer than 8 months, 16 and longer than 24 months. 20,26 Other series did not observe an association between survival and RFI.…”

“…4 -26 The benefit of secondline chemotherapy in the treatment of recurrent OS is less clear. [7][8][9][10][11][12][13]15,16,19,20,25,26 Several factors complicate the analysis of the published literature regarding DFS and survival after OS recurrence. First, some series represented selected cohorts of patients amenable to surgical excision, thereby excluding patients with unresectable (and therefore unfavorable) recurrent tumors.…”