Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma.
ABSTRACT Although survival without resection of pulmonary metastases from osteosarcoma is unlikely, not all surgeons agree on an aggressive surgical approach. We have taken an approach to attempt surgical resection if at all feasible regardless of number of metastases and disease-free interval (DFI). This study presents information on long-term follow-up after this aggressive approach to resection.
A single-institution retrospective cohort study of osteosarcoma patients younger than 21 years with pulmonary metastases, limited to the contemporary chemotherapeutic period (1980-2000), was conducted.
In 137 patients, synchronous (23.4%) or metachronous (76.6%) pulmonary nodules were identified. The median follow-up was 2.0 years (5 days to 20.1 years) for all patients. Overall survival among patients who had pulmonary nodules was 40.2% and 22.6% at 3 and 5 years, respectively. Ninety-nine patients underwent attempted pulmonary metastasectomy (mean survival, 33.6 months; 95% confidence interval, 25.1-42.1) and 38 patients did not (mean survival, 10.1 months; 95% confidence interval, 6.5-13.6; P < .001, t test). Characteristics that were associated with an increased likelihood of 5-year overall survival after pulmonary resection were primary tumor necrosis greater than 98% after neoadjuvant chemotherapy (P < .05) and DFI before developing lung metastases more than 1 year (P < .001). No statistically significant difference in overall survival or disease-free survival was found based on the number of pulmonary metastases resected. Characteristics including primary tumor size, site, or extension; chemotherapy; early vs late metastases; unilateral vs bilateral metastases; and resection margins did not significantly affect survival.
Most patient and tumor characteristics commonly used by surgeons to determine utility of resection of pulmonary metastases among patients with osteosarcoma are not associated with outcome. Biology of the particular tumor (response to preoperative chemotherapy, measured by tumor necrosis percentage, and DFI), as opposed to tumor burden, appears to influence survival more significantly. We would advocate considering repeat pulmonary resection for patients with recurrent metastases from osteosarcoma.
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ABSTRACT: The aim of our study was to assess the postoperative course of bilateral anterior sternothoracotomy (BAT) in children with sarcoma metastases, in a curative care perspective.World Journal of Surgical Oncology 07/2014; 12(1):233. · 1.09 Impact Factor
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ABSTRACT: Background: Radiofrequency ablation (RFA) has demonstrated its effectiveness in controlling metastases measuring less than 3 cm in several adult malignancies but not yet in osteosarcoma. We report our experience of RFA in the treatment of metastases in adolescents and young adults (AYA) with osteosarcoma. Procedure: Sixteen patients treated for osteosarcoma in French Society of Childhood Cancer centers had undergone an RFA procedure between 2006 and 2012. Results: Thirteen sessions were performed in 10 patients to treat 22 lung metastases. Seven patients were in complete remission at last follow up (range 19-51 months; median, 24 months after RFA). None had a recurrence at RFA sites. We report three cases each of hemoptysis and pneumothorax. Eight sessions were performed in seven patients to treat bone lesions. Procedure was intended as: curative for a small metastatic lesion (n = 3, all in remission more than 3 years after); local control of small bone lesions in multi-metastatic diseases (n = 3); analgesia (n = 1). Complications included one first-degree burn, one fracture, and one soft tissue infection. Conclusions: RFA is feasible in AYA with osteosarcoma. It efficiently achieved local control of small peripheral lung metastases. Its role in the curative care of small secondary bone lesions remains to be confirmed.Pediatric hematology and oncology. 07/2014;
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ABSTRACT: Patients with untreated metastatic disease have a less than 5 % to 10 % 5-year survival, and for the patient who has metastatic disease isolated to the lungs, pulmonary metastasectomy remains the best hope for cure. Pulmonary metastasectomy has been performed for decades. However, despite hundreds of studies spanning several decades, randomized control data in support of pulmonary metastasectomy is still lacking, and the evidence upon which we base this commonly accepted surgical practice is for the most part weak. While well-accepted surgical selection criteria exist, controversies related to pulmonary metastasectomy abound. Unanswered and clearly debatable are questions related to: optimal preoperative imaging, if mediastinal staging should be performed and if so when, is video-assisted thoracic surgery (VATS) equivalent to open thoracotomy, is finger palpation of the lung mandatory, is repeat pulmonary metastasectomy justified, and what is the interrelationship of pulmonary metastasectomy to other treatments. Current practice to the surgical approach to pulmonary metastasectomy remains quite variable.Current Treatment Options in Oncology 07/2014; · 2.42 Impact Factor