Resection of Pulmonary Metastases in Osteosarcoma. Is it Justified?
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Hellenic Journal of Surgery (2018) 90:6, 293-298
Resection of Pulmonary Metastases in Osteosarcoma. Is it Justified? de Bree E1, Drositis I2, Michelakis D1, Mavroudis D3
Abstract Osteosarcoma shows a high propensity to metastasize to the lung. Pulmonary metastases occur in approximately 40% of patients with osteosarcoma during the course of their disease, and the lung is the only site of metastatic disease in the majority of these cases. Chemotherapy continues to be the standard treatment for metastatic sarcoma, but when it is the only treatment modality, it still results in poor survival rates. In order to improve the outcome, a combination of chemotherapy followed by surgical resection of the metastases has been advocated for selected cases. Substantial evidence
documents the potential benefit of pulmonary metastasectomy in osteosarcoma, resulting, in various series, in a 5-year overall survival of 30-40%. Aggressive surgery in combination with chemotherapy appears to be justified for metastatic osteosarcoma in selected patients, and it is associated with acceptable morbidity. Synchronous metastases, a short interval from diagnosis to presentation of pulmonary metastasis, a higher number (>4) of metastases, bilateral and central location, pleural infiltration, poor response to preoperative chemotherapy and concurrent (resectable) extra-pulmonary disease have all been associated with a less favorable outcome. Complete surgical resection is essential for giving a chance of long-term survival. Lateral thoracotomy with salvage of as much lung parenchyma as possible is the procedure of choice. Repeat surgery for re-recurrences is feasible and beneficial, resulting in prolonged survival in a number of cases. Key words: Osteosarcoma; lung metastases; surgery
Introduction Sarcomas are rare malignancies and represent a heterogeneous group of tumors, arising from both soft tissues and bone. Multimodality treatment for osteosarcoma allows reaching 5-year survival rates of from 30% to 80% [1]. Osteosarcoma shows a high propensity to metastasize to the lung; pulmonary
metastases occur in approximately 40% of patients with osteosarcoma during the course of their disease, and the lung is the only site of metastatic disease in the majority of these patients [2-4]. The development of pulmonary metastases has a considerable negative impact on prognosis, with most untreated patients dying within one year of diagnosis [2]. Chemotherapy continues to be the standard treatment for metastatic sarcoma, but when it is the only treatment modality, 1
Department of Surgical Oncology, Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery 3 Department of Medical Oncology 2
Medical School of Crete University Hospital, Heraklion, Greece Corresponding author: de Bree Eelco, MD, PhD Department of Surgical Oncology, University Hospital, P.O. Box 1352, 71110 Heraklion, Greece Tel.: +30 2810 392056 / 392382, Fax: +30 2810 392382 e-mail: [email protected] Received Nov 25, 2018; Accepted Jan 16, 2019
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