918 PULMONARY METASTASIS IN OSTEOSARCOMA: A REVIEW OF TREATMENT AND OUTCOME IN 88 PEDIATRIC PATIENTS

Abstract

We analyzed the records of 88 patients <21 years of age who had the initial diagnosis of osteosarcoma established at Mayo between 1972 and 1981, and subsequently developed pulmonary metastases (PM). All had classic high grade extremity or girdle primary lesions with no evidence of PM at diagnosis based on imaging techniques in use at that time. All patients were considered for surgical resection if PM represented the sole site of active disease and the lesions appeared resectable on radiographic studies. Sixty nine of 88 children underwent 148 thoracotomy episodes (1 thoracotomy episode was defined as 1 or 2 thoracotomies performed for unilateral or simultaneously diagnosed bilateral PM). Twenty three children are currently alive, 21 disease free. All disease-free survivors (DFS) had successful surgical excision of their PM, median number of thoracotomy episodes= 2 (range= 1-6). Fifteen DFS had concurrent or sequential bilateral pulmonary involvement. Eleven DFS received no adjuvant therapy after their last thoracotomy. The median follow-up since the last PM for the 21 DFS is 77 months (range= 12-117), 19 being free of tumor >27 months. Of the children who underwent >1 thoracotomy, 23/69 (33%) are currently alive. None of the 19 patients not subjected to thoracotomy survived. Of children considered to be surgical candidates at the time of the most recent PM, 23/51 (45%) are alive. Overall, 23/88 (26%) patients survive. We conclude that surgical excision of PM plays a major role in the successful treatment of metastatic osteosarcoma. Supported in part by NCI grant #CA15083.

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