Pulmonary Resection for Metastatic Osteosarcomas: A Retrospective Analysis of 21 Patients

Abstract

Background: The use of pulmonary resection for metastatic osteosarcoma as an interdisciplinary treatment concept is being established. The purpose of this study was to determine the clinical course, outcome and prognostic factors in a subset of patients having undergone aggressive polychemotherapy in the most recent period and metastasectomy. Methods: Between 1997 and 2001, 21 patients (8 men, 13 women) with pulmonary metastases from osteosarcoma of the limb underwent surgical resection. Exclusion of primary tumor recurrence and other extrapulmonary metastases was mandatory for inclusion in the study. Complete resection was achieved in 18 patients. The median follow-up was 60.6 months. Results: Cumulative 5-year survival after complete resection was 34.2 %. Of the prognostic factors analyzed, age, sex, repeated thoracotomy, and histologic grading did not influence survival. Complete resection was found to be a significant prognostic factor for survival following metastasectomy (p = 0.04). There was a tendency towards longer survival in patients with less than 7 pulmonary metastases compared to patients with more than 7 metastases, but the difference was not statistically significant (p = 0.07). Conclusion: With pulmonary metastases of osteosarcoma, every attempt should be made to completely resect all clinically detected metastases. Repeat thoracotomy in recurrent disease is compatible with long-term survival.

Key words

Pulmonary metastases - metastatic osteosarcoma - prognostic factors

References

• 1 Huth J F, Eilber F R. Patterns of recurrence after resection of osteosarcoma of the extremity. Strategies for treatment of metastases.  Arch Surg. 1989;  124 122-126
• 2 Ward W G, Mikaelian K, Dorey F. et al . Pulmonary metastases of stage IIB extremity osteosarcoma and subsequent pulmonary metastases.  J Clin Oncol. 1994;  12 1849-1858
• 3 Bentzen S M. Prognostic factor studies in oncology: osteosarcoma as a clinical example.  Int J Radiat Oncol Biol Phys. 2001;  49 513-518
• 4 Meyers P A, Heller G, Healey J H. et al . Osteogenic sarcoma with clinically detectable metastasis at initial presentation.  J Clin Oncol. 1993;  11 449-453
• 5 Bielack S, Kempf-Bielack B, Schwenzer D. et al . Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the Cooperative Osteosarcoma Study Group COSS of 925 patients.  Klin Pädiatr. 1999;  211 260-270
• 6 Abel U, Berger J, Wiebelt H. CRITLEVEL: an exploratory procedure for the evaluation of quantitative prognostic factors.  Methods Inf Med. 1984;  23 154-156
• 7 Kaplan E LMP. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
• 8 Peto R PJ. Asymptomatically efficient rank invariant test procedures.  J R Stat Soc A. 1972;  135 185-206
• 9 Kager L, Zoubek A, Potschger U. et al . Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols.  J Clin Oncol. 2003;  21 2011-2018
• 10 Skinner K A, Eilber F R, Holmes E C, Eckardt J, Rosen G. Surgical treatment and chemotherapy for pulmonary metastases from osteosarcoma.  Arch Surg. 1992;  127 1065-1070 1070-1071 (discussion)
• 11 Di Lorenzo M, Collin P P. Pulmonary metastases in children: results of surgical treatment.  J Pediatr Surg. 1988;  23 762-765
• 12 Tsuchiya H, Kanazawa Y, Abdel-Wanis M E. et al . Effect of timing of pulmonary metastases identification on prognosis of patients with osteosarcoma: the Japanese Musculoskeletal Oncology Group study.  J Clin Oncol. 2002;  20 3470-3477
• 13 Loehe F, Kobinger S, Hatz R A, Helmberger T, Loehrs U, Fuerst H. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy.  Ann Thorac Surg. 2001;  72 225-229
• 14 Ercan S, Nichols 3rd F C. Prognostic significance of lymph node metastasis found during pulmonary metastasectomy for extrapulmonary carcinoma.  Ann Thorac Surg. 2004;  77 1786-1791
• 15 Jablons D, Steinberg S M, Roth J, Pittaluga S, Rosenberg S A, Pass H I. Metastasectomy for soft tissue sarcoma. Further evidence for efficacy and prognostic indicators.  J Thorac Cardiovasc Surg. 1989;  97 695-705
• 16 Inoue K, Yamamoto R, Nishiyama N. et al . Prognostic factors of resected pulmonary metastases of osteogenic sarcoma.  Nippon Kyobu Geka Gakkai Zasshi. 1996;  44 1065-1069
• 17 Meyer W H, Schell M J, Kumar A P. et al . Thoracotomy for pulmonary metastatic osteosarcoma. An analysis of prognostic indicators of survival.  Cancer. 1987;  59 374-379
• 18 Tabone M D, Kalifa C, Rodary C, Raquin M, Valteau-Couanet D, Lemerle J. Osteosarcoma recurrences in pediatric patients previously treated with intensive chemotherapy.  J Clin Oncol. 1994;  12 2614-2620
• 19 Saltzman D A, Snyder C L, Ferrell K L, Thompson R C, Leonard A S. Aggressive metastasectomy for pulmonic sarcomatous metastases: a follow-up study.  Am J Surg. 1993;  166 543-547
• 20 Antunes M, Bernardo J, Salete M, Prieto D, Eugenio L, Tavares P. Excision of pulmonary metastases of osteogenic sarcoma of the limbs.  Eur J Cardiothorac Surg. 1999;  15 592-596
• 21 Beattie E J, Harvey J C, Marcove R, Martini N. Results of multiple pulmonary resections for metastatic osteogenic sarcoma after two decades.  J Surg Oncol. 1991;  46 154-155
• 22 Pastorino U, Gasparini M, Tavecchio L. et al . The contribution of salvage surgery to the management of childhood osteosarcoma.  J Clin Oncol. 1991;  9 1357-1362
• 23 Bacci G, Mercuri M, Briccoli A. et al . Osteogenic sarcoma of the extremity with detectable lung metastases at presentation. Results of treatment of 23 patients with chemotherapy followed by simultaneous resection of primary and metastatic lesions.  Cancer. 1997;  79 245-254
• 24 Holmes E C. Pulmonary metastases. Pearson GF, Deslauriers J, Ginsberg RJ, Hiebert CA, McKneally MF, Urschel HC Thoracic Surgery. Philadelphia; Churchill Livingstone 1995: 827-834