Pulmonary resection for metastatic osteosarcomas: A retrospective analysis of 21 patients

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.