Management of osteosarcoma pulmonary metastases
Section snippets
Imaging
An integral part of the management of osteosarcoma pulmonary metastases is the ability to image such disease with radiologic studies. The current radiographic “gold standard” for identification and localization of metastatic OS is helical computed tomography (CT) scanning.4 Although the speed and quality of resolution continue to improve, current CT scanning may miss small metastases (particularly those ≤5 mm in diameter).10, 11 The sensitivity of helical CT scanning is around 80% for all types
Prognostic characteristics
It is important to understand the impact of multiple patient and tumor characteristics on prognosis in children presenting with pulmonary metastases from osteosarcoma. The majority of retrospective case series that have addressed this question have found that number of metastases, disease-free interval from diagnosis to presentation of metastases, ability to completely resect the nodules, and the percentage “tumor necrosis” of the primary tumor after induction chemotherapy are the primary
Biology of metastases
It would obviously be preferable to prevent pulmonary metastases rather than be forced to surgically remove these lesions once identified. A hindrance in the development of effective therapies to decrease the occurrence of metastatic disease is an incomplete understanding of the biology of the metastatic process. Although an exhaustive review of the investigation into the biology of osteosarcoma is beyond the scope of this article, the practicing pediatric surgeon should be aware of the types
Surgical management issues
Although resection of osteosarcoma pulmonary metastases is a relatively uncommon procedure within the broad scope of pediatric surgical practice, there is no uniformity of surgical opinion on how to manage these patients beyond the belief that an aggressive approach is warranted and that without resection essentially all patients will succumb to their disease. We recently reviewed the M.D. Anderson Cancer Center experience with a focus on an aggressive approach to pulmonary resection. Although
References (40)
- et al.
Aggressive thoracotomy for pulmonary metastatic osteogenic sarcoma in children and young adolescents
J Pediatr Surg
(1981) - et al.
Computed tomography of pulmonary metastases from osteosarcoma: the less poor technique. A study of 51 patients with histological correlation
Ann Oncol
(2001) - et al.
FDG-PET for detection of pulmonary metastases from malignant primary bone tumorscomparison with spiral CT
Ann Oncol
(2001) - et al.
Predictive factors of disease-free survival for non-metastatic osteosarcoma of the extremityan analysis of 300 patients treated at the Rizzoli Institute
Ann Oncol
(2001) - et al.
Prognostic and therapeutic relevance of HER2 expression in osteosarcoma and Ewing’s sarcoma
Eur J Cancer
(2005) - et al.
Surgical management and outcome of osteosarcoma patients with unilateral pulmonary metastases
J Pediatr Surg
(2004) - et al.
Transxiphoid video-assisted pulmonary metastasectomyrelevance of helical computed tomography occult lesions
Ann Thorac Surg
(2000) Median sternotomy for resection of pulmonary metastases
J Thorac Cardiovasc Surg
(1983)- et al.
Malignant bone tumors
- et al.
Osteosarcoma of bone and its important recognizable varieties
Am J Surg Pathol
(1977)
Osteosarcoma and other bone tumors
Osteosarcoma
Phase II/III trial of etoposide and high-dose ifosfamide in newly diagnosed metastatic osteosarcomaa pediatric oncology group trial
J Clin Oncol
Presurgical window of carboplatin and surgery and multidrug chemotherapy for the treatment of newly diagnosed metastatic or unresectable osteosarcomaPediatric Oncology Group Trial
J Pediatr Hematol Oncol
Prognostic significance of complete surgical resection of pulmonary metastases in patients with osteogenic sarcomaanalysis of 32 patients
J Clin Oncol
Pulmonary metastases of stage IIB extremity osteosarcoma and subsequent pulmonary metastases
J Clin Oncol
Optimizing the surgical management of lung nodules in children with osteosarcomathoracoscopy for biopsies, thoracotomy for resections
Surg Endosc
Pulmonary metastasescan accurate radiological evaluation avoid thoracotomic approach?
Eur J Cardiothorac Surg
Prognostic factors and imaging patterns of recurrent pulmonary nodules after thoracotomy in children with osteosarcoma
Cancer
Osteosarcoma relapse after combined modality therapyan analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS)
J Clin Oncol
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