Multimodal Treatment of Osteosarcoma Lung Metastases

Abstract

Objective: The diagnostic procedures, role of surgery and multimodal treatment for osteosarcoma pulmonary metastases are examined. Methods: From January 2000 to June 2005, we observed 35 patients with osteogenic repetitions. Patients were studied by total-body computerised tomography (CT) and by thoracic single-photon emission computerised tomography (SPECT). Preoperative histological diagnosis was obtained by CT-guided transthoracic needle biopsy (23 cases) and fibre-optic bronchoscopy (12 cases). Results: Four lower, 6 upper and 2 middle lobectomies were carried out using a thoracotomy approach. Video-assisted thoracoscopy was used in the other 23 patients who underwent 36 wedge resections. CT showed a sensitivity of 86 % and a specificity of 66 %; SPECT had a sensitivity of 80 % and a specificity of 100 %. Twenty-five patients are still living 25 ± 11 months after the intervention. Conclusions: SPECT was demonstrated to offer a better result in the individualisation of secondary pulmonary nodules after primary osteosarcoma. The excision of all resectable lung metastases, integrated in a multidisciplinary strategy, offers good results in terms of survival.

Osteosarcoma - SPECT - lung metastases - multimodal therapy

References

• 1 Filderman A E, Coppage L, Shaw C, Matthay R A. Pulmonary and pleural manifestations of extrathoracic malignancies.  Clin Chest Med. 1989;  10 747-807
• 2 Mogulkoc N, Goker E, Atasever A, Veral A, Ozkok S, Bishop P W. Endobronchial metastasis from osteosarcoma of bone.  Chest. 1999;  116 1811-1814
• 3 Pastorino U. Lung metastasectomy: why, when, how.  Crit Rev Oncol Hematol. 1997;  26 137-145
• 4 Pevarski D J, Drane W E, Scarborough M T. The usefulness of bone scintigraphy with SPECT images for detection of pulmonary metastases from osteosarcoma.  AJR. 1998;  170 319-322
• 5 Franzius C, Daldrup-Link H E, Sciuk J, Rummeny E J, Bielack S, Jurgens H, Schober O. FDG‐PET for detection of pulmonary metastases from malignant primary bone tumours: comparison with spiral CT.  Ann Oncol. 2001;  12 479-486
• 6 Milleron B, Capron F, Calais G, Mangiapan G, Rosencher L, Wdowick A, Dromer C, Lemarié E. Cancers bronchopulmonaires secondaires.  Encycl Méd Chir (Elsevier, Paris) Pneumologie. 1996;  6-002-6-70 1-14
• 7 Szafranski A, Wozniak W. Metastases to the lungs in patients with osteogenic sarcoma-treatment results.  Med Wieku Rozwoj. 2000;  4 77-83
• 8 Yonemoto T, Tatezaki S, Ishii T, Satoh T, Kimura H, Iwai N. Prognosis of osteosarcoma with pulmonary metastases at initial presentation is not dismal.  Clin Orthop. 1998;  349 194-199
• 9 Shibamoto Y, Horii N, Takahashi M. Long-term control of multiple lung metastases from osteosarcoma obtained by conventional radiotherapy: a case report.  Oncol Rep. 1999;  6 1085-1087
• 10 McCarville M B, Kaste S C, Cain A M, Goloubeva O, Rao B N, Pratt C B. Prognostic factors and imaging patterns of recurrent pulmonary nodules after thoracotomy in children with osteosarcoma.  Cancer. 2001;  91 1170-1176
• 11 Pastorino U, Grunenwald D. Pulmonary metastases. Pearson FG, Cooper JD, Deslauriers J, Ginsberg RJ, Hiebert CA, Patterson GA, Urschel Jr HC Thoracic Surgery. 2nd ed. New York; Churchill Livingstone 1995: 962-973
• 12 Putnam J P, Roth J A. Surgical treatment for pulmonary metastases from sarcoma.  Hematol Oncol Clin North Am. 1995;  9 869-887
• 13 Torre W, Rábago G, Barba J, Sierrasesúmaga L, Baixauli J, Galbis J. Combined surgical approach for sarcoma lung metastasis with atrial involvement.  Thorac Cardiovasc Surg. 1999;  47 125-127
• 14 Davidson R S, Nwogu C E, Brentjens M J, Anderson T M. The surgical management of pulmonary metastases: current concepts.  Surg Oncol. 2001;  10 35-42
• 15 Mineo T C, Ambrogi V, Paci M, Iavicoli N, Pompeo E, Nofroni I. Transxifoid bilateral palpation in video-assisted thoracoscopic lung metastasectomy.  Arch Chir. 2001;  136 783-788