Lung metastasectomy for osteosarcoma in children, adolescents, and young adults: proof of permanent cure

Abstract

Introduction Surgical resection of pulmonary metastases has been associated with increased survival at 5 years for osteosarcoma, but limited information is available on long-term outcome, role of repeated metastasectomies, and surgical sequelae in a pediatric population. We analyzed a consecutive series of children, adolescents, and young adults (AYA) treated by repeated lung metastasectomies during a period >40 years to estimate the clinical benefit and potential cure rate of salvage surgery. Methods All patients who underwent lung metastasectomy for osteosarcoma at the IRCCS Istituto Ortopedico Rizzoli of Bologna, University of Modena, and IRCCS Istituto Nazionale Tumori of Milan from May 1973 to January 2014 were included. Overall survival (OS) at 20 years from the first metastasectomy was calculated. Results A total of 463 consecutive children and AYA were analyzed. Median age was 15.9 years (range 0.2–23.2 years) and median follow-up 18.6 years. The 5- and 20-year OS were 34.0% and 29.7% (95% CI 25.5–34.0%). Among the 138 (29.8%) alive patients, 42 (30.4%) had disease recurrence cured by repeated metastasectomies. Disease-free interval from primary tumor, number of metastases, and complete resection were the most relevant survival predictors at multivariable model analysis. Discussion The extended follow-up of this consecutive series shows that repeated lung metastasectomy can achieve a permanent cure when offered to properly selected patients with metastases from osteosarcoma.

Establishment of a prognostic risk model for osteosarcoma and mechanistic investigation

“…The rapid progression and metastasis of OS pose significant challenges for its treatment. Approximately 20% of patients present with lung metastasis at the time of diagnosis, and the majority of recurrent OS cases involve lung metastasis ( Pastorino et al, 2023 ). Current standard treatments for OS include neoadjuvant chemotherapy, surgical resection of the primary tumor, and adjuvant chemotherapy.…”

Development and Validation a nomogram to predict the risk of pulmonary metastasis in pediatric osteosarcoma

“…Ugo et al studied 463 children, adolescents, and young adults with pulmonary metastases from osteosarcoma, with a median age of 15.9 years (range 0.2-23.2 years). The multivariate analysis revealed that the disease-free interval, the number of metastases, and complete resection of the primary tumor were the most important factors predicting survival [31]. The independent risk factors for pulmonary metastasis of pediatric osteosarcoma were investigated.…”

Survival outcomes and surgical morbidity based on surgical approach to pulmonary metastasectomy in pediatric, adolescent and young adult patients with osteosarcoma

“…11 For decades, thoracotomy has been the primary surgical approach in order to manually identify radiographically undetectable lesions by palpating calcified microscopic OST nodules. 12 Thoracotomy with manual exploration of lungs continues to be the recommended surgical approach in metastatic OST. In contrast, since the emergence of videoassisted thoracoscopic surgery (VATS) in the early 1990s as a minimally invasive alternative approach for lung cancer surgery, VATS has been established as the gold standard for surgical resection of early-stage lung cancer, 13 and is increasingly being utilized to resect pulmonary metastases in many cancers, including OST.…”

“…Aggressive PMs have been shown to improve survival in patients with metastatic OST since the 1970s 11 . For decades, thoracotomy has been the primary surgical approach in order to manually identify radiographically undetectable lesions by palpating calcified microscopic OST nodules 12 . Thoracotomy with manual exploration of lungs continues to be the recommended surgical approach in metastatic OST.…”