The metastatic patterns of osteosarcoma

Abstract

Summary.-The paper presents a detailed comparison of the anatomical distribution and frequency of clinically evident metastases in 152 cases of osteosarcoma, and autopsy findings in 43 cases. The behaviour of long bone tumours is contrasted with those arising elsewhere, which tend to metastasize less widely because of early death from effects of the primary tumour. In both clinical and autopsy series long bone tumours produced lung metastases (LM) in over 90% of patients dying with metastases, but the terminal frequency of extra-pulmonary metastases (EPM) rises from a clinical level of 33% to 83% at autopsy.There was little difference between tumours of the major long bones in the frequency of either LM or EPM, but EPM from the humerus tended to be fewer and sited above the diaphragm and from the femur below it. EPM most often involved other bones, notably vertebrae and pelvis. Not more than 10% of tumours invaded regional lymph nodes but terminally a quarter of the long bone tumours had metastasized to heart and abdomen. The infrequency of metastases in muscle was confirmed.The median time for LM was 5-6 months after starting treatment, for EPM 9-10. months. First metastases after 24 months were infrequent, especially in children. With delay in the appearance of metastases, whether LM or EPM, post-metastatic survival lengthened. Neither age, sex nor mode of treatment of the primary notably affected metastatic frequency, although recurrences were much more numerous when radiotherapy, even with high dosage, was the definitive treatment. Local recurrence usually appeared within 6-8 months and was shown to lead to increased frequency of osseous metastases. It is suggested that terminal dissemination may often be tertiary but not always from a pulmonary secondary. THE PAST 30 years' experience of the treatment of osteosarcoma shows universally bad results for any large series of cases. This is due both to the intrinsic limitations of current therapeutic methods and to concentration upon control or destruction of the primary tumour only, although it becomes increasingly obvious that the overwhelming lethal factor is distant metastatic growth, particularly in the lungs. With tumours of long bones, which comprise the great majority of osteosarcomata presenting in young people, lung secondaries are almost invariably the cause of death, even though metastases in other sites are not infrequent and are also potentially lethal.The explosion in diversity and scope of chemotherapy in the last decade is already producing better prognoses for some solid tumours. It is hoped that the use of cytotoxic drugs in the treatment of osteosarcoma may prolong the disease-free survival in this tumour also. Planned treatment along these lines requires a precise knowledge of tumour behaviour, especially of the dominating metastatic activity. We present an analytical study of the metastatic patterns of osteosarcoma arising in otherwise normal bones, as found both clinically

Osteosarcoma of the cranial vault and skull base in pediatric patients

“…Korn reich et al 42 reported on a patient who was found to have osteoblastic osteosarcoma of the distal femur and a calvarial metastasis. 26,36,42 The tumor invaded the dura and could not be separated from it. 42 The metastatic tu- mor in our series also demonstrated extensive dural invasion, whereas both primary tumors did not.…”

Osteosarcoma of the Metatarsal Bones: Review of the Literature and Report of a Case

“…Moreover, Dahlin 8z Coventry (1967) and Jaffe (1958) found a better 5-year survival after tumours affecting the tibia than the femur. Jeffree et al (1975) found relatively few extrapulmonary metastases from tumours in the tibia. Others (Stanley 8z MacKenzie 1964, Scranton et al 1975 could not confirm this finding.…”

Endobronchial Metastasis from an Osteosarcoma Case

“…En sık uzak metastaz görülen organ akciğerlerdir. Osteosarkom metastazlarının yaklaşık %80'i akciğer metastazlarıdır (14)(15)(16). Bu yazıda bahsedilen www.respircase.com olguda tutulan bölge proksimal humerustu ve tanı esnasında takibe alınması planlanan kalsifiye plevral plakların, kontrol tomografilerde progrese olmalarıyla metastaz oldukları anlaşıldı.…”