The contribution of salvage surgery to the management of childhood osteosarcoma.

Abstract

Between January 1970 and December 1988, 174 consecutive patients under the age of 20 years with curatively resected primary osteosarcoma were treated at our institute; 72 in the years of 1970 to 1981 and 102 in the years 1982 to 1988. In the latter period, adjuvant chemotherapy was replaced by neoadjuvant programs, and new criteria were adopted for the management of lung metastases, consisting in early bilateral surgical staging and lung resection through median sternotomy for all patients with purely intrathoracic relapse. Follow-up was updated in December 1989. During the last period, the overall 5-year survival improved significantly from 35% to 58% (P less than .001). The disease-free survival rose from 38% to 45% at 5 years, with median values of 15 months versus 33 months, while the frequency of isolated lung metastases dropped from 58% to the actuarial 48%. The proportion of patients who underwent complete resections of their pulmonary metastases rose from 17% (seven of 42) to 55% (27 of 49), without operative mortality. Due to such a high proportion of patients eligible for salvage surgery, the overall survival from detection of lung metastases improved from 0% to 28% at 5 years (P less than .001). Contralateral occult metastases were resected in three of 15 subjects with monolateral clinical lesions, and five patients underwent subsequent lung resections. These data indicate that systematic bilateral pulmonary resection plays an important role in improving the final cure rate of childhood osteosarcoma, beyond the benefit resulting from neoadjuvant chemotherapy.

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

“…In many series, the number of patients treated with second-line chemotherapy was too small to draw conclusions regarding the impact on survival. 7,21 Pastorino et al 13 and Tabone et al 15 observed no difference in survival with or without second-line chemotherapy. However, chemotherapy was given selectively to patients with multiple pulmonary nodules or with an RFI shorter than 1 year RFI 13 or to patients with multiple recurrent tumors or tumors that were difficult to resect.…”

“…7,21 Pastorino et al 13 and Tabone et al 15 observed no difference in survival with or without second-line chemotherapy. However, chemotherapy was given selectively to patients with multiple pulmonary nodules or with an RFI shorter than 1 year RFI 13 or to patients with multiple recurrent tumors or tumors that were difficult to resect. 15 In contrast, Saeter et al 19 concluded that the delivery of "modern intensive chemotherapy" (p. 1090) improved overall survival when compared with patients treated with no or inadequate chemotherapy.…”

“…Inability to achieve CR2 has been associated with an exceptionally poor outcome, with overall survival rates ranging from 0% to 8%. 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.…”

“…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.…”

Metastasectomy in pediatric patients: indications, technical tips and outcomes

“…The systematic salvage surgery combined with an effective chemotherapy demonstrated the survival's improvement. An aggressive approach resulted to be effective in improving survival, which reached 68% and 58% after 3 and 5 years respectively (14).…”