Nonresectable multiple lung metastases of high-grade osteosarcoma of the humerus: stable after twelve years. A case report.

Thanks to the combination of surgery and adjuvant or neoadjuvant chemotherapy, the outcome for patients with nonmetastatic osteosarcoma of an extremity has improved dramatically over the last twenty years. For this group of patients, the five-year overall rate of survival increased from less than 15% in the 1970s1,2 to more than 65% as of the time of writing3,4. Patients with osteosarcoma of the extremity who present with lung metastasis (about 20% of all cases) have a poorer prognosis than those without metastases. Nonetheless, with the combination of chemotherapy and complete surgical removal of primary and secondary lesions, the survival of patients with metastases has improved from less than 5% to more than 20%5,6. However, when complete excision of all of the secondary lesions is impossible, the five-year survival rate becomes extremely low and almost all of these patients die within three years from the time of diagnosis5. We report an unusual case of a patient with osteosarcoma of the extremity and with multiple bilateral nonresectable lung metastatic lesions at the time of presentation, who was treated with chemotherapy and surgery of only the primary tumor and who appears to have stable lung metastatic disease twelve years after the initial diagnosis. The parents of the patient were informed that data concerning the case would be submitted for publication and they consented. A seven-year-old girl was admitted to our hospital in January 1995 with a three-week history of pain in the left upper arm. Physical examination revealed a hard and tender swelling in the proximal part of the humerus. The only abnormal result of laboratory tests was a very high level of alkaline phosphatase (1600 U/L; normal values, 190-490 U/L). A radiograph showed a large osteolytic lesion at the …