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Treatment of Osteosarcoma Patients with Pulmonary Metastasis

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Osteosarcoma

Abstract

The lung is the most common site of relapse from osteosarcoma. Several studies revealed that the patients with pulmonary metastases of osteosarcoma have a poor prognosis. This article aims to describe the current understanding of the characteristics, prognostic factors, and the local treatment strategy for pulmonary metastases of osteosarcoma.

Several clinical characteristics, such as a number or laterality of pulmonary nodules, location, or time interval from initial treatment, have been reported as potential prognostic factors for the patients with pulmonary metastases. Meanwhile, outcome of the patients with pulmonary metastases at initial presentation is not a dismal when the appropriate chemotherapy and thoracotomy are performed.

As a treatment factor, complete surgical resection of the pulmonary metastases is a most important predictor for survival of those patients, although the benefit of video-assisted thoracoscopic surgery or multiple thoracotomy is still controversial.

The number of published data available regarding the efficacy of radiotherapy in the treatment of pulmonary metastases is limited. Emerging techniques including stereotactic body radiotherapy and radiofrequency ablation could be an effective option of the treatment for unresectable metastatic lesion.

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References

  1. Meyers PA, Heller G, Healey JH, Huvos A, Applewhite A, Sun M, et al. Osteogenic sarcoma with clinically detectable metastasis at initial presentation. J Clin Oncol. 1993;11(3):449–53.

    CAS  PubMed  Google Scholar 

  2. Kager L, Zoubek A, Potschger U, Kastner U, Flege S, Kempf-Bielack B, et al. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. J Clin Oncol. 2003;21(10):2011–8. doi:10.1200/JCO.2003.08.132.

    Article  PubMed  Google Scholar 

  3. Kempf-Bielack B, Bielack SS, Jurgens H, Branscheid D, Berdel WE, Exner GU, et al. Osteosarcoma relapse after combined modality therapy: an analysis of unselected patients in the Cooperative Osteosarcoma Study Group (COSS). J Clin Oncol. 2005;23(3):559–68. doi:10.1200/JCO.2005.04.063.

    Article  PubMed  Google Scholar 

  4. Bacci G, Briccoli A, Longhi A, Ferrari S, Mercuri M, Faggioli F, et al. Treatment and outcome of recurrent osteosarcoma: experience at Rizzoli in 235 patients initially treated with neoadjuvant chemotherapy. Acta Oncol. 2005;44(7):748–55. doi:10.1080/02841860500327503.

    Article  CAS  PubMed  Google Scholar 

  5. Bacci G, Ferrari S, Longhi A, Perin S, Forni C, Fabbri N, et al. Pattern of relapse in patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy. Eur J Cancer. 2001;37(1):32–8.

    Article  CAS  PubMed  Google Scholar 

  6. Hawkins DS, Arndt CA. Pattern of disease recurrence and prognostic factors in patients with osteosarcoma treated with contemporary chemotherapy. Cancer. 2003;98(11):2447–56. doi:10.1002/cncr.11799.

    Article  PubMed  Google Scholar 

  7. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin N Am. 1997;44(4):973–89.

    Article  CAS  Google Scholar 

  8. Bielack SS, Kempf-Bielack B, Branscheid D, Carrle D, Friedel G, Helmke K, et al. Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients. J Clin Oncol. 2009;27(4):557–65. doi:10.1200/JCO.2008.16.2305.

    Article  PubMed  Google Scholar 

  9. Leary SE, Wozniak AW, Billups CA, Wu J, McPherson V, Neel MD, et al. Survival of pediatric patients after relapsed osteosarcoma: the St. Jude Children’s Research Hospital experience. Cancer. 2013;119(14):2645–53. doi:10.1002/cncr.28111.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Iwata S, Yonemoto T, Iizasa T, Niibe Y, Kamoda H, Ishii T. Oligo-recurrence of osteosarcoma patients: treatment strategies for pulmonary metastases. Ann Surg Oncol. 2015 Jun 20. doi:10.1245/s10434-015-4682-1.

    Google Scholar 

  11. Tsuchiya H, Kanazawa Y, Abdel-Wanis ME, Asada N, Abe S, Isu K, 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(16):3470–7.

    Article  PubMed  Google Scholar 

  12. Briccoli A, Rocca M, Salone M, Bacci G, Ferrari S, Balladelli A, et al. Resection of recurrent pulmonary metastases in patients with osteosarcoma. Cancer. 2005;104(8):1721–5. doi:10.1002/cncr.21369.

    Article  PubMed  Google Scholar 

  13. Ferrari S, Briccoli A, Mercuri M, Bertoni F, Picci P, Tienghi A, et al. Postrelapse survival in osteosarcoma of the extremities: prognostic factors for long-term survival. J Clin Oncol. 2003;21(4):710–5.

    Article  PubMed  Google Scholar 

  14. Wu PK, Chen WM, Chen CF, Lee OK, Haung CK, Chen TH. Primary osteogenic sarcoma with pulmonary metastasis: clinical results and prognostic factors in 91 patients. Jpn J Clin Oncol. 2009;39(8):514–22. doi:10.1093/jjco/hyp057.

    Article  PubMed  Google Scholar 

  15. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.

    CAS  PubMed  Google Scholar 

  16. Bacci G, Rocca M, Salone M, Balladelli A, Ferrari S, Palmerini E, et al. High grade osteosarcoma of the extremities with lung metastases at presentation: treatment with neoadjuvant chemotherapy and simultaneous resection of primary and metastatic lesions. J Surg Oncol. 2008;98(6):415–20. doi:10.1002/jso.21140.

    Article  PubMed  Google Scholar 

  17. 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 Relat Res. 1998;349:194–9.

    Article  PubMed  Google Scholar 

  18. Carter SR, Grimer RJ, Sneath RS, Matthews HR. Results of thoracotomy in osteogenic sarcoma with pulmonary metastases. Thorax. 1991;46(10):727–31.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Letourneau PA, Xiao L, Harting MT, Lally KP, Cox Jr CS, Andrassy RJ, et al. Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome. J Pediatr Surg. 2011;46(7):1333–7. doi:10.1016/j.jpedsurg.2010.12.013.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Harting MT, Blakely ML, Jaffe N, Cox Jr CS, Hayes-Jordan A, Benjamin RS, et al. Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma. J Pediatr Surg. 2006;41(1):194–9. doi:10.1016/j.jpedsurg.2005.10.089.

    Article  PubMed  Google Scholar 

  21. Chou AJ, Merola PR, Wexler LH, Gorlick RG, Vyas YM, Healey JH, et al. Treatment of osteosarcoma at first recurrence after contemporary therapy: the Memorial Sloan-Kettering Cancer Center experience. Cancer. 2005;104(10):2214–21. doi:10.1002/cncr.21417.

    Article  PubMed  Google Scholar 

  22. Salah S, Fayoumi S, Alibraheem A, Massad E, Abdel Jalil R, Yaser S, et al. The influence of pulmonary metastasectomy on survival in osteosarcoma and soft-tissue sarcomas: a retrospective analysis of survival outcomes, hospitalizations and requirements of home oxygen therapy. Interact Cardiovasc Thorac Surg. 2013;17(2):296–302. doi:10.1093/icvts/ivt177.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Kayton ML, Huvos AG, Casher J, Abramson SJ, Rosen NS, Wexler LH, et al. Computed tomographic scan of the chest underestimates the number of metastatic lesions in osteosarcoma. J Pediatr Surg. 2006;41(1):200–6. doi:10.1016/j.jpedsurg.2005.10.024; discussion -6.

    Article  PubMed  Google Scholar 

  24. Partrick DA, Bensard DD, Teitelbaum DH, Geiger JD, Strouse P, Harned RK. Successful thoracoscopic lung biopsy in children utilizing preoperative CT-guided localization. J Pediatr Surg. 2002;37(7):970–3; discussion -3.

    Article  PubMed  Google Scholar 

  25. Parida L, Fernandez-Pineda I, Uffman J, Davidoff AM, Gold R, Rao BN. Thoracoscopic resection of computed tomography-localized lung nodules in children. J Pediatr Surg. 2013;48(4):750–6. doi:10.1016/j.jpedsurg.2012.09.051.

    Article  PubMed  Google Scholar 

  26. Sugi K, Kaneda Y, Hirasawa K, Kunitani N. Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions. Chest. 2003;124(1):155–8.

    Article  PubMed  Google Scholar 

  27. Gow KW, Saad DF, Koontz C, Wulkan ML. Minimally invasive thoracoscopic ultrasound for localization of pulmonary nodules in children. J Pediatr Surg. 2008;43(12):2315–22. doi:10.1016/j.jpedsurg.2008.08.031.

    Article  PubMed  Google Scholar 

  28. Chen F, Miyahara R, Bando T, Okubo K, Watanabe K, Nakayama T, et al. Repeat resection of pulmonary metastasis is beneficial for patients with osteosarcoma of the extremities. Interact Cardiovasc Thorac Surg. 2009;9(4):649–53. doi:10.1510/icvts.2009.212498.

    Article  PubMed  Google Scholar 

  29. Kandioler D, Kromer E, Tuchler H, End A, Muller MR, Wolner E, et al. Long-term results after repeated surgical removal of pulmonary metastases. Ann Thorac Surg. 1998;65(4):909–12.

    Article  CAS  PubMed  Google Scholar 

  30. Suzuki M, Iwata T, Ando S, Iida T, Nakajima T, Ishii T, et al. Predictors of long-term survival with pulmonary metastasectomy for osteosarcomas and soft tissue sarcomas. J Cardiovasc Surg. 2006;47(5):603–8.

    CAS  Google Scholar 

  31. Burgers JM, van Glabbeke M, Busson A, Cohen P, Mazabraud AR, Abbatucci JS, et al. Osteosarcoma of the limbs. Report of the EORTC-SIOP 03 trial 20781 investigating the value of adjuvant treatment with chemotherapy and/or prophylactic lung irradiation. Cancer. 1988;61(5):1024–31.

    Article  CAS  PubMed  Google Scholar 

  32. Caldwell WL. Elective whole lung irradiation. Radiology. 1976;120(3):659–66. doi:10.1148/120.3.659.

    Article  CAS  PubMed  Google Scholar 

  33. Giritsky AS, Etcubanas E, Mark JB. Pulmonary resection in children with metastatic osteogenic sarcoma: improved survival with surgery, chemotherapy, and irradiation. J Thorac Cardiovasc Surg. 1978;75(3):354–62.

    CAS  PubMed  Google Scholar 

  34. Yu W, Tang L, Lin F, Li D, Wang J, Yang Y, et al. Stereotactic radiosurgery, a potential alternative treatment for pulmonary metastases from osteosarcoma. Int J Oncol. 2014;44(4):1091–8. doi:10.3892/ijo.2014.2295.

    PubMed Central  PubMed  Google Scholar 

  35. Mehta N, Selch M, Wang PC, Federman N, Lee JM, Eilber FC, et al. Safety and efficacy of stereotactic body radiation therapy in the treatment of pulmonary metastases from high grade sarcoma. Sarcoma. 2013;2013:360214. doi:10.1155/2013/360214.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Nakamura T, Matsumine A, Yamakado K, Matsubara T, Takaki H, Nakatsuka A, et al. Lung radiofrequency ablation in patients with pulmonary metastases from musculoskeletal sarcomas [corrected]. Cancer. 2009;115(16):3774–81. doi:10.1002/cncr.24420.

    Article  PubMed  Google Scholar 

  37. Palussiere J, Italiano A, Descat E, Ferron S, Cornelis F, Avril A, et al. Sarcoma lung metastases treated with percutaneous radiofrequency ablation: results from 29 patients. Ann Surg Oncol. 2011;18(13):3771–7. doi:10.1245/s10434-011-1806-0.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba, 260-8717, Japan

    Shintaro Iwata, Tsukasa Yonemoto, Hiroto Kamoda & Takeshi Ishii

Authors
  1. Shintaro Iwata
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  2. Tsukasa Yonemoto
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  3. Hiroto Kamoda
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  4. Takeshi Ishii
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Correspondence to Takeshi Ishii .

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Editors and Affiliations

  1. Osaka National Hospital, Osaka University, Osaka, Osaka, Japan

    Takafumi Ueda

  2. National Cancer Center Hospital, Tokyo, Tokyo, Japan

    Akira Kawai

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Iwata, S., Yonemoto, T., Kamoda, H., Ishii, T. (2016). Treatment of Osteosarcoma Patients with Pulmonary Metastasis. In: Ueda, T., Kawai, A. (eds) Osteosarcoma. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55696-1_19

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  • DOI: https://doi.org/10.1007/978-4-431-55696-1_19

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