Osteosarcoma is the most common primary malignancy of bone in children and young adults, the highest incidence peak is during adolescence and doesn't have any gender predominance. The main site of metastasis are the lungs and extrapulmonary cases are occasional. The incidence of metastasis in the Central Nervous System (CNS) is 2-6.5%, increase to 10-15% in patients with pulmonary metastases. Therefore, metastatic disease of the CNS is rare and the information on such patients is limited. Here, we describe a case of a 20-year old patient diagnosed with osteosarcoma in the left distal femur stage IIB, he developed pulmonary disease, during palliative chemotherapy experienced relapse to the brain classified as (RPA) class II, and was treated with external radiotherapy (30 Gy in 10 fractions) and later he had a poor evolution and died.

trial (NCT01171170 1), body composition was characterized by CSA and distribution of both muscle and adipose tissue at the third lumbar level on CT-images obtained at baseline and three weeks after start of chemotherapy. Changes in body composition parameters were related to OS with Kaplan Meier and log-rank test. Cox multivariate analysis was performed to assess the relative contribution of muscle and adipose tissue CSA and distribution to OS. Result: Data were available of 103 patients. Cox regression analysis showed that loss of muscle CSA and IMAT independently affected survival while change in SAT and VAT did not. 74 patients (72%) exhibited muscle loss (group 1) versus 29 patients (28%) who had stable or gain of muscle CSA (group 2). Groups were comparable regarding age, WHO PS, TNM status, and Charlson comorbidity index. Median OS (95% CI) was 10.0 (7.9-12.2) months in group 1 and 15.3 (11.1-19.5) months in group 2 (p¼0.004). Among muscle losing patients two subgroups were distinguished based on IMAT change. Loss of muscle mass combined with loss of IMAT (group 1a, n¼33) also showed significant loss of SAT and lower survival rates compared to loss of muscle mass with preserved IMAT (group 1b, n¼40). Median OS (95% CI) was 7.3 (5.0-9.5) months in group 1a compared to 12.9 (9.2-16.6) months (p<0.001) in group 1b. Conclusion: Early changes in body composition patterns during the first cycle of chemotherapy in metastatic NSCLC are predictive for OS and might be useful for more personalized supportive intervention during followup treatment. Reference: 1. Dingemans AM, Groen HJ, Herder GJ et al. A randomized phase II study comparing paclitaxel-carboplatin-bevacizumab with or without nitroglycerin patches in patients with stage IV nonsquamous nonsmall-cell lung cancer: NVALT12 (NCT01171170) dagger.