Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Osteosarcomas with lung metastases are rather heterogenous group. Funding: The authors have no support or funding to report. Patients and Methods This study is designed as retrospective analysis of adolescent and adult high-grade osteosarcoma patients with lung metastases, either synchronous or metachronous.
Results A total of 93 high-grade osteosarcoma patients with lung metastases were analysed. Download: PPT. Table 1. Patient and tumor characteristics, with comparison of clinicopathological characteristics between patients with synchronous lung metastases Group A and patients with metachronous lung metastases Group B. Fig 1. Post-lung metastases survival PLM-OS for the time to first lung metastses and for the treatment modalities.
Fig 2. Overall survival for the treatment modalities for lung metastases. Fig 3. Table 2. Overall survival and survival after first lung metastases of 93 patients. Table 3. Univariate analysis of potantial prognostic variables for overall survival after first lung metastases. Table 4. Multivariate analysis for relapse free survival and overall survival after lung metastases.
Discussion Osteosarcomas with lung metastases are heterogenous group. References 1. Ritter J, Bielack SS. Ann Oncol Oct;21 Suppl 7 :vii—5.
J Clin Oncol ;23 3 — Osteosarcoma in adolescents and adults: survival analysis with and without lung metastases. Ann Oncol ;20 6 — Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol ;21 10 — Osteogenic sarcoma with clinically detecetable metastasis at initial presentation.
J Clin Oncol ; — Survival of pediatric patients after relapsed osteosarcoma: The St. Jude Children's Research Hospital experience. Cancer ; 14 — Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol ;21 4 — PLoS One. View Article Google Scholar 9. Prognostic factors in pulmonary metastasized high-grade osteosarcoma.
Pediatr Blood Cancer ; 54 2 — All patients had thoracotomy and about one third received chemotherapy. Our study confirms that patients with recurrent osteosarcoma presenting as a single pulmonary nodule more than 1 year after diagnosis represent a favourable group of patients who can be cured by surgery alone. The use of chemotherapy at first relapse did not improve outcome.
Although the long-term prognosis for patients with recurrent osteosarcoma remains poor, some progress has been made in identifying risk factors that can be used for patient stratification and tailoring salvage therapy. Hawkins and Arndt reported that for patients with initial pulmonary recurrence, the presence of solitary pulmonary nodules was associated with improved disease-free survival and OS.
The COSS study demonstrated that bilateral pulmonary metastases and pleural disruption were poor prognostic factors Kempf-Bielack et al, Surgical resection of pulmonary metastases, whenever feasible, has been long considered standard treatment Carter et al, , van Geel et al, , Harting et al, Thoracotomy with wedge resection has been the preferred surgical approach for removal of lung nodules; a median sternotomy does not allow full exploration of the posterior pulmonary segments for nodules that may not have been radiologically evident.
All patients in our study underwent thoracotomy for removal of the lung nodule. However, a recent study suggested that a minimally invasive approach to nodule removal with image-guided localisation, if needed, should be considered in patients with single pulmonary nodule because ipsilateral metastases are not likely to be found Fernandez-Pineda et al, The use of chemotherapy for patients with isolated pulmonary recurrence of osteosarcoma has been widely debated.
One significant consideration for using a surgical-only treatment approach is to avoid the potential acute and late toxicities of chemotherapy. However, the improved survival for patients treated with surgery alone likely reflects a biased use of chemotherapy in patients with incompletely resected disease. Ferrari et al reported that PRS was positively influenced by the use of second-line chemotherapy in patients who did not have complete surgery, but not in patients who had complete surgery.
In their subgroup analysis of patients with isolated pulmonary recurrence who had complete surgical remission, PRS was better in patients with two or fewer nodules and a relapse-free interval longer than 24 months. In the COSS study of the largest cohort of patients with recurrent osteosarcoma, the use of second-line chemotherapy, particularly chemotherapy with more than one agent, was associated with better OS for the entire cohort and for patients without second complete remission, but not for patients with second complete remission Kempf-Bielack et al, In patients who achieved a second complete remission, second-line chemotherapy positively correlated with event-free survival but not OS.
Another study based on single institutional experience did not demonstrate a survival advantage for those patients who received chemotherapy compared with patients who only underwent surgical resection for first recurrence Crompton et al, Analysis of our cohort did not reveal survival advantage with the use of chemotherapy.
Thus, the lack of evidence for benefit from salvage chemotherapy and the relatively favourable outcome of patients with relapsed osteosarcoma presenting as a single pulmonary nodule support the use of surgery only for treating these patients. Our study is limited by its retrospective nature and the small cohort size that may have affected our ability to further delineate whether some of the clinical prognostic factors would have reached statistical significance.
Because our study included only patients who had a relapse more than 1 year after diagnosis and the median time to relapse was 2. In the COSS study, a correlation was noted between solitary site of relapse and longer interval to relapse Kempf-Bielack et al, In conclusion, our multi-institutional study demonstrated that approximately half of the patients with recurrent osteosarcoma as a solitary pulmonary nodule more than 1 year after diagnosis were long-term survivors.
Whether this improved outcome compared with that of patients with recurrent osteosarcoma in general could be related to low disease burden or favourable tumour biology remains to be determined. Our analyses did not reveal factors that help identify patients who are likely to survive or die, although there was a trend for improved outcome for those with smaller nodules or later relapse.
It is hoped that clinical genomics or the ability to detect circulating sarcoma cells will help discern which patients will require further therapy in addition to surgery Chen et al, , Satelli et al, While the use of salvage chemotherapy did not confer a survival advantage in our study, perhaps novel therapies that are likely to be effective in the setting of minimal residual disease such as immunotherapy, will prove to be beneficial.
This paper was modified 12 months after initial publication to switch to Creative Commons licence terms, as noted at publication. Acta Oncol 44 : — Eur J Cancer 41 : — Bacci G, Mercuri M, Longhi A, Ferrari S, Bertoni F, Versari M, Picci P c Grade of chemotherapy-induced necrosis as a predictor of local and systemic control in patients with non-metastatic osteosarcoma of the extremities treated with neoadjuvant chemotherapy in a single institution.
Cancer : — Article Google Scholar. Thorax 46 : — Jude Children's Research Hospital Washnington University Pediatric Cancer Genome Recurrent somatic structural variations contribute to tumorigenesis in pediatric osteosarcoma. Cell Rep 7 : — If you are diagnosed with osteosarcoma and secondary lung cancer at the same time you will probably have:.
You meet your surgical team before your surgery. The surgeon talks to you about the risks and benefits. They ask you to sign a consent form. This is a good time to ask all the questions you need to. Surgery for secondary lung cancer is a major operation. As the surgeon needs to operate inside the chest, you have an operation called a thoracotomy.
Your surgeon opens the chest wall between the ribs to get to your lungs. Opening the chest makes the lung on that side collapse. You have a chest drain after the operation so that your lung fills up with air again reinflate.
The drain is a tube that comes out of your chest and is connected to a bottle with gentle suction. The tube helps blood and fluid to drain out of the wound. The suction helps the lung to inflate again after the operation. You might have this procedure done as keyhole surgery. If signs are pointing to a bone tumor such as an osteosarcoma, here are some of the tests that might be done to find out more:.
Bone x-ray: This is often the first test done if a doctor suspects a bone tumor. MRIs can show details about the bone and nearby areas. This helps the doctor plan for a biopsy see below and surgery. CT scan: This test uses x-rays to make detailed pictures of a person's insides. A CT scan of the chest may be done to see if cancer has spread to the lungs.
Bone scan: A bone scan can help show if a cancer has spread to other bones. This test is useful because it can show all of the bones in the body at once. PET scan: PET scans use a special kind of sugar that can be seen inside the body with a special camera. This test can help show if the cancer has spread, as well as if the cancer is being helped by treatment.
In a biopsy, the doctor takes out a small piece of bone to check it for cancer cells. A biopsy is the only way to tell for sure if a person has a bone cancer like osteosarcoma. For tumors in a bone, the biopsy should be done by doctors who often treat bone tumors. The biopsy and surgery to remove the tumor should be planned at the same time, and the same doctors should do both. This can help prevent problems later on.
The biopsy can be done either by surgery, or by putting a hollow needle into the bone. Ask your doctor what kind will be done. The cancer cells in the biopsy sample will be given a grade , based on how they look. This helps doctors know how fast the cancer is likely to grow and spread.
Higher grade cancers tend to grow faster. Low grade cancer cells usually grow slowly and are less likely to spread. Ask the doctor to explain the grade of the cancer.
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