Treatment and prognosis of pulmonary metastasis of osteosarcoma

Most patients with osteosarcoma succumb to respiratory failure due to pulmonary metastasis.The adage “The infallible cure of an osteosarcoma dependa upon control of its pulmonary metastasis” should be kept in mind.A total of 44 patients with pulmonary metastatic osteosarcoma after the completion of our treatment schedule were evaluated in this study.All patients had thoracotomies performed by wedge resection as the standard treatment of choice.Of the 44 patients 31 were treated with repeated or bilateral thoracotomies (11 via sternotomies and one-stage bilateral thoracotomies).Factors that improved survival seemed to be a relatively long the interval, 6-12 months, between the onset of the primary tumor and the appearance of pulmonary metastasis, a mitotic ratio of 10 and rapid and strongly osteoid formation of metastatic foci. En bloc resection of the pericardium, chest wall, and diaphragm did not enhance survival.Patients with 15 metastatic foci and less than 3 thoracotomies had a good prognosis.In this series 44 patients 6 year survival rate after treatment was 11.3%.