1
|
Eisenberg M, Deboever N, Hofstetter WL, Mehran RJ, Rice DC, Rajaram R, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB. Pulmonary Surgical Margins for Metastatic Osteosarcoma: Is Negative Margin Enough? Ann Thorac Surg 2024:S0003-4975(24)00440-5. [PMID: 38839027 DOI: 10.1016/j.athoracsur.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND In advanced osteosarcoma, the lung is the most frequent site of distant metastasis, with metastasectomy often used for local disease control. The influence of pulmonary resection margin length on outcomes for osteosarcoma has not been well explored. This study sought to evaluate the impact of margin length relative to tumor size on local recurrence and survival in lung-limited metastatic osteosarcoma. METHODS Patients with metastatic osteosarcoma who underwent lung resection between 2000 and 2020 were identified from a single institution. Clinicopathologic variables were collected. The margin length-to-tumor size ratio (MTR) was calculated per nodule and classified relative to an MTR of 0.5. The primary outcome was development of local recurrence per nodule. Multivariate logistic regression was used to investigate covariates. RESULTS A total of 142 patients with 689 nodules met inclusion criteria, with mean age of 35.6 years (interquartile range [IQR], 20.9-46.6 years). Patients were predominantly male (n = 87; 61.3%) and White (n = 106; 72.5%). Most nodules (n = 644; 93.5%) were resected through thoracotomy. The mean tumor size was 0.8 cm (IQR, 0.5-1.70 cm), with an average margin length of 0.3 cm (IQR, 0.1-0.7 cm). Among all nodules, 299 (43.4%) had an MTR >0.5. Systemic therapy was received by 94 patients (66.2%) preoperatively and by 100 patients (70.4%) postoperatively. Importantly, the study found that an MTR >0.5 conferred a protective effect against disease recurrence (hazard ratio, 0.67; 95% CI, 0.52-0.87; P = .003). CONCLUSIONS In resected pulmonary metastatic osteosarcoma, a margin length greater than one-half the size of the pulmonary nodule is associated with a lower incidence of local disease recurrence. This finding has implications for the subsequent need for additional therapy and disease-free status, thus meriting attentive intraoperative consideration.
Collapse
Affiliation(s)
- Michael Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
2
|
Mettmann VL, Blattmann C, Friedel G, Harrabi S, von Kalle T, Kager L, Kevric M, Kühne T, Nathrath M, Sorg B, Werner M, Bielack SS, Hecker-Nolting S. Primary Multi-Systemic Metastases in Osteosarcoma: Presentation, Treatment, and Survival of 83 Patients of the Cooperative Osteosarcoma Study Group. Cancers (Basel) 2024; 16:275. [PMID: 38254767 PMCID: PMC10813782 DOI: 10.3390/cancers16020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To evaluate patient and tumour characteristics, treatment, and their impact on survival in patients with multi-systemic metastases at initial diagnosis of high-grade osteosarcoma. Precedure: Eighty-three consecutive patients who presented with multi-systemic metastases at initial diagnosis of high-grade osteosarcoma were retrospectively reviewed. In cases of curative intent, the Cooperative Osteosarcoma Study Group recommended surgical removal of all detectable metastases in addition to complete resection of the primary tumour and chemotherapy. RESULTS Eighty-three eligible patients (1.8%) were identified among a total of 4605 individuals with high-grade osteosarcoma. Nine (10.8%) of these achieved complete surgical remission, of whom seven later had recurrences. The median follow-up time was 12 (range, 1-165) months for all patients. Actuarial event-free survival after 1, 2, and 5 years was 9.6 ± 3.2%, 1.4 ± 1.4%, and 1.4 ± 1.4%, and overall survival was 54.0 ± 5.6%, 23.2 ± 4.9%, and 8.7 ± 3.3%. In univariate analyses, elevated alkaline phosphatase before chemotherapy, pleural effusion, distant bones as metastatic sites, and more than one bone metastasis were negative prognostic factors. Among treatment-related factors, the microscopically complete resection of the primary tumour, a good response to first-line chemotherapy, the macroscopically complete resection of all affected tumour sites, and local treatment (surgery ± radiotherapy) of all bone metastases were associated with better outcomes. Tumour progression under first-line treatment significantly correlated with shorter survival times. CONCLUSION The outlook for patients with multi-systemic primary metastases from osteosarcoma remains very poor. The utmost importance of surgical resection of all tumour sites was confirmed. For unresectable bone metastases, radiotherapy might be considered. In the patient group studied, standard chemotherapy was often insufficiently effective. In the case of such advanced disease, alternative treatment options are urgently required.
Collapse
Affiliation(s)
- Vanessa L. Mettmann
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Claudia Blattmann
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Godehard Friedel
- Department of Thoracic Surgery, Faculty of Science, University of Tubingen, 72076 Tubingen, Germany
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Centre (HIT), Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Thekla von Kalle
- Radiologic Institute, Centre for Paediatric, Adolescent and Women’s Medicine, Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Leo Kager
- St. Anna Children’s Hospital, University Hospital for Paediatric and Adolescent Medicine of the Medical University and St. Anna Children’s Cancer Research Institute (CCRI), 1090 Vienna, Austria
| | - Matthias Kevric
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Thomas Kühne
- University Children’s Hospital Basel, 4031 Basel, Switzerland
| | - Michaela Nathrath
- Department of Paediatrics and Children’s Cancer Research Centre, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Paediatric Haematology and Oncology, Klinikum Kassel, 34125 Kassel, Germany
| | - Benjamin Sorg
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Mathias Werner
- Osteopathology Reference Centre, Institute of Pathology, Vivantes Klinikum im Friedrichshein, 10249 Berlin, Germany
| | - Stefan S. Bielack
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
- Department for Paediatric Haematology and Oncology, University’s Children’s Hospital Muenster, 48149 Muenster, Germany
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| |
Collapse
|
3
|
Prognostic Impact of Pulmonary Metastasectomy in Bone Sarcoma Patients: A Retrospective, Single-Centre Study. Cancers (Basel) 2023; 15:cancers15061733. [PMID: 36980620 PMCID: PMC10046382 DOI: 10.3390/cancers15061733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/05/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
This retrospective study aimed at analyzing the impact of metastasectomy on post-metastasis survival (PMS) in bone sarcoma patients with lung metastases. Altogether, 47 bone sarcoma patients (24 males, median age at diagnosis of lung metastases: 21.8 (IQR: 15.6–47.3) years) with primary (n = 8) or secondary (n = 39) lung metastases treated at a single university hospital were retrospectively included. Based on a propensity score, inverse probability of treatment weight (IPTW) was calculated to account for selection bias whether patients had undergone metastasectomy or not. The most common underlying histology was osteosarcoma (n = 37; 78.7%). Metastasectomy was performed in 39 patients (83.0%). Younger patients (p = 0.025) with singular (p = 0.043) and unilateral lesions (p = 0.024), as well as those with an interval ≥ 9 months from primary diagnosis to development of lung metastases (p = 0.024) were more likely to undergo metastasectomy. Weighted 1- and 3-year PMS after metastasectomy was 80.8% and 58.3%, compared to 88.5% and 9.1% for patients who did not undergo metastasectomy. Naive Cox-regression analysis demonstrated a significantly prolonged PMS for patients with metastasectomy (HR: 0.142; 95%CI: 0.045–0.450; p = 0.001), which was confirmed after IPTW-weighting (HR: 0.279; 95%CI: 0.118–0.662; p = 0.004), irrespective of age, time to metastasis, and the number of lesions. In conclusion, metastasectomy should be considered in bone sarcoma patients with lung metastases, after carefully considering the individual risks, to possibly improve PMS.
Collapse
|
4
|
Bone sarcoma follow-up; a nationwide analysis of oncological events after initial treatment. J Bone Oncol 2022; 38:100466. [PMID: 36578650 PMCID: PMC9791116 DOI: 10.1016/j.jbo.2022.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Aim Follow-up strategies for high-grade bone sarcomas have been optimized to facilitate early detection of local recurrence and distant metastasis. The ideology is that early detection enables early treatment presuming better survival. However, the clinical value for each individual patient remains questionable. This study aims to evaluate oncological events after initial treatment in order to assess current follow-up strategies for high-grade bone sarcomas in the Netherlands. Patients and Methods A retrospective cohort study was conducted based on a national registry. All cases were retrieved from the Netherlands Cancer Registry. Our study consisted of 393 patients treated between 2007 and 2011 with complete follow-up data. Baseline characteristics were analysed for all entities. Local recurrence and distant metastasis was analysed along with overall survival for high-grade chondrosarcoma, high-grade osteosarcoma, Ewing sarcoma and chordoma. Results Median follow-up was 8,3 years for high-grade chondrosarcoma, 4,9 for high-grade osteosarcoma, 3,8 for Ewing sarcoma and 7,5 for chordoma. Median time to local recurrence and distant metastasis was 1,2 years for high-grade osteosarcoma and 1,5 years for Ewing sarcoma. For high-grade osteosarcoma with localized disease at presentation, 0.09 new distant metastatic events per patient per year were seen after five years of follow-up with 11,1 patients needed to follow-up for any event. Five-year overall survival was 60,0% for high-grade chondrosarcoma, 50,0% for high-grade osteosarcoma, 45,3% for Ewing sarcoma and 71,4% for chordoma. Conclusions This nationwide study shows a plateau in local recurrences and distant metastatic events after four years of treatment for patients with high-grade osteosarcoma and Ewing sarcoma. Due to a lack of reliable evidence however, we were not able to provide additional guidance on follow-up intervals and duration. Collaborative research with larger groups is needed in order to provide a solid scientific recommendation for follow-up in the heterogenous patient population with bone sarcoma.
Collapse
|
5
|
Ahmed G, Elshafiey M, Romeih M, Elgammal A, Kamel A, Salama A, Nesma Farid, Zaky I. Prognostic significance of the ratio of surgically resected to radiologically detected lung nodules in patients with metastatic osteosarcoma. Surg Oncol 2021; 40:101701. [PMID: 34992029 DOI: 10.1016/j.suronc.2021.101701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
The factors that affect the prognosis of patients' metastatic osteosarcoma are still poorly understood. In this study, we investigated a new prognostic factor, the ratio of surgically resected to radiologically detected osteosarcoma lung nodules (SR/RD), which may have predictive value. PATIENTS AND METHODS Data from patients with metastatic osteosarcoma who underwent metastasectomy between January 2009 and December 2020, in a single center, were reviewed. The relationships between survival and the SR/RD ratio, timing of lung metastases, number of nodules, laterality, and presence of tumor necrosis at first metastasectomy were investigated. RESULTS Among the 125 metastatic osteosarcoma patients, 80 patients had an SR/RD ratio ≤1. The median duration of follow-up was 72 months, ranging from 6 to 118 months. The five-year overall survival (OS) and postmetastasectomy event-free survival (EFS) for all patients were 36.5% and 18.1%, respectively. The five-year OS of patients with a low SR/RD ratio was 49.6% and that of patients with a high SR/RD ratio was 11.8 (P = 0.001). The two-year postmetastasectomy EFS rates of the high and low ratio groups were 24.1% and 9.4%, respectively (P = 0.001). The SR/RD ratio, number of nodules, and tumor necrosis had significant effects on OS and postmetastasectomy EFS in univariate analysis. A Cox proportional hazard model demonstrated that tumor necrosis and an SR/RD ratio >1 were associated with OS (HR = 1.8 and 2.01) and postmetastasectomy EFS (HR = 1,69 and 1.97). CONCLUSIONS A high SR/RD ratio of greater than 1 and poor tumor necrosis were significantly associated with poor survival among patients with metastatic osteosarcoma who had lung metastasectomy. The high SR/RD ratio may be a surrogate outcome for incomplete metastatic tumor resection.
Collapse
Affiliation(s)
- Gehad Ahmed
- Department of General Surgery, Faculty of Medicine, Helwan University, Egypt; Children's Cancer Hospital, 57357, Egypt.
| | - Maged Elshafiey
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Egypt; Children's Cancer Hospital, 57357, Egypt
| | - Marwa Romeih
- Department of Radio Diagnosis, Faculty of Medicine, Helwan University, Egypt
| | - Ahmed Elgammal
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt; Children's Cancer Hospital, 57357, Egypt
| | - Ahmed Kamel
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, Egypt; Children's Cancer Hospital, 57357, Egypt
| | - Asmaa Salama
- Department of Pathology, National Cancer Institute, Cairo University, Egypt; Children's Cancer Hospital, 57357, Egypt
| | - Nesma Farid
- Research Department Children's Cancer Hospital, Egypt
| | - Iman Zaky
- Department of Radiology, National Cancer Institute, Cairo University, Egypt; Children's Cancer Hospital, 57357, Egypt
| |
Collapse
|
6
|
Stork T, Boemans R, Hardes J, Streitbürger A, Dirksen U, Pöttgen C, Schildhaus HU, Bauer S, Collaud S, Aigner C. Number of metastases and their response to chemotherapy impact survival of patients with isolated lung metastases from bone-derived sarcoma. BMC Cancer 2021; 21:375. [PMID: 33827467 PMCID: PMC8028220 DOI: 10.1186/s12885-021-08073-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary metastasectomy (PM) is an established treatment for selected patients with metastatic sarcomas. The aim of this study was to examine our institutional experience and evaluate factors predicting outcome. Methods We retrospectively reviewed all patients undergoing PM for bone sarcoma in our center from 2001 to 2019. Survival was calculated from the date of PM. Impact on survival of clinical parameters was assessed. Results Thirty-eight patients (27 males, 71%) were included. Histology was osteosarcoma (n = 20, 53%), Ewing sarcoma (n = 13, 34%) and chondrosarcoma (n = 5, 13%). Twelve patients (31.5%) had synchronous metastases, all received chemotherapy before PM. Median number of metastases was 3 (1 to 29). Twenty (53%) patients had mediastinal lymph node sampling. One patient had positive lymph nodes. Ninety-day mortality was 0%. Three and 5-year PFS were 24.5 and 21%, respectively. Three and 5-year OS were 64.5 and 38.5%, respectively. More than three metastases and progression under chemotherapy were significant independent predictors for OS. Conclusion PM is a safe procedure and encouraging long-term outcome can be achieved. Patients with progression of pulmonary metastases under chemotherapy as well as patients with more than three metastases had significantly worse OS.
Collapse
Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Rebecca Boemans
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Uta Dirksen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Essen, Germany.,Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Ruhrlandklinik, Tüschener Weg 40, 45239, Essen, Germany. .,German Cancer Consortium (DKTK), Center Essen, Essen, Germany.
| |
Collapse
|
7
|
Follow-Up in Bone Sarcoma Care: A Cross-Sectional European Study. Sarcoma 2020; 2020:2040347. [PMID: 32675939 PMCID: PMC7350160 DOI: 10.1155/2020/2040347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/17/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Follow-up of high-grade bone sarcoma patients with repeated radiological imaging aims at early detection of recurrent disease or distant metastasis. Repeated radiological imaging does expose (mostly young) patients to ionising radiation. At this point, it is not known whether frequent follow-up increases overall survival. Additionally, frequent follow-up subjects patients and families to psychological stress. This study aims to assess follow-up procedures in terms of frequency and type of imaging modalities in bone tumour centres across Europe for comparison and improvement of knowledge as a first step towards a more uniform approach towards bone sarcoma follow-up. Methods Data were obtained through analysis of several follow-up protocols and a digital questionnaire returned by EMSOS members of bone tumour centres all across Europe. Results All participating bone tumour centres attained a minimum follow-up period of ten years. National guidelines revealed variations in follow-up intervals and use of repeated imaging with ionising radiation. A local and a chest X-ray were obtained at 47.6% of the responding clinics at every follow-up patient visit. Conclusions Variations were seen among European bone sarcoma centres with regards to follow-up intervals and use of repeated imaging. The majority of these expert centres follow existing international guidelines and find them sufficient as basis for a follow-up surveillance programme despite lack of evidence. Future research should aim towards evidence-based follow-up with focus on the effects of follow-up strategies on health outcomes, cost-effectiveness, and individualised follow-up algorithms.
Collapse
|
8
|
Hashimoto K, Nishimura S, Oka N, Akagi M. Outcomes of comprehensive treatment for primary osteosarcoma. SAGE Open Med 2020; 8:2050312120923177. [PMID: 32547749 PMCID: PMC7249600 DOI: 10.1177/2050312120923177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/03/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose: This study aimed to evaluate the clinical features and outcomes of osteosarcoma to identify prognostic factors and determine new strategies to improve overall survival. Patients and Methods: We retrospectively analyzed 12 cases of osteosarcoma treated at our hospital from 2012 to 2017. Tumor site, tissue type, stage, treatments, adverse effects, postoperative limb function, surgical margin, and final outcomes were evaluated. Results: All patients received chemotherapy, and 10 underwent wide resection. The Musculoskeletal Tumor Society scores were more than good in all cases, and the 3-year survival rate was 73.3%. Two patients are alive with disease, eight have remained disease-free, and two died of the disease. Three of the four recurrent cases involved the pelvis. Conclusion: The treatment of primary osteosarcoma with wide resection in our department, therefore, yielded favorable outcomes. However, improved treatment strategies are needed for pelvic and advanced cases.
Collapse
Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Japan
| | - Shunji Nishimura
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Japan
| | - Naohiro Oka
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Japan
| |
Collapse
|
9
|
Ahmed G, Zamzam M, Kamel A, Ahmed S, Salama A, Zaki I, Kamal N, Elshafiey M. Effect of timing of pulmonary metastasis occurrence on the outcome of metastasectomy in osteosarcoma patients. J Pediatr Surg 2019; 54:775-779. [PMID: 30005831 DOI: 10.1016/j.jpedsurg.2018.06.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/16/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Complete metastasectomy is the best predictor of survival in patients with osteosarcoma pulmonary metastases. There has been some controversy in the literature regarding the prognostic significance of the timing of occurrence of lung metastasis. METHODS We reviewed the clinical course of all osteosarcoma patients with pulmonary metastases treated by metastasectomy in our hospital from January 2008 through December 2016. Each patient who underwent metastasectomy was placed into one of three groups based on whether lung metastases were present at initial presentation (Group 1), developed during chemotherapy (Group 2), or appeared after completion of chemotherapy (Group 3). Data were obtained retrospectively and follow-up was obtained until the end of June 2017. RESULTS We identified 170 patients with pulmonary nodules of whom 99 (58.2%) underwent at least one metastasectomy (149 thoracotomies). Eleven patients had benign pulmonary nodules and were excluded. The other 88 patients were classified as Group 1 (37), Group 2 (18) or Group 3 (33). The median follow-up was 35 months (range 8 to 99). Postmetastasis 5-year overall survival (OS) was 38.1 ± 6.4%; event-free survival (EFS) was 25 ± 5.3%. By group, postmetastasis 5-year OS and EFS were 34.3 ± 13% and 18 ± 9.3% in Group 1, 8 ± 6.5% and 6.5 ± 5% in Group 2, and 52 ± 11.4% and 25 ± 9% in Group 3 (P < 0.001). In univariate analysis, the only significant factors associated with survival were timing of occurrence of lung metastasis and the number of lung nodules found. CONCLUSION The timing of occurrence of lung metastasis is an important prognostic factor among osteosarcoma patients eligible for metastasectomy. Patients whose metastases occurred during chemotherapy had the worst survival. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Gehad Ahmed
- Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt; Surgical Oncology Department, Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt.
| | - Manal Zamzam
- Pediatric Oncology Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Kamel
- Pediatric Oncology Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sonia Ahmed
- Pediatric Oncology Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| | - Asmaa Salama
- Pathology Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Zaki
- Radiodiagnosis Department, CCHE, Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| | - Nehal Kamal
- Clinical Research Department, CCHE, Cairo, Egypt
| | - Maged Elshafiey
- Surgical Oncology Department, Children's Cancer Hospital, Egypt (CCHE), Cairo, Egypt; National Cancer Institute, Cairo University, Cairo, Egypt
| |
Collapse
|
10
|
Yamamoto Y, Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Outani H, Takenaka S, Hamada K, Yoshikawa H, Okumura M. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol 2019; 24:863-870. [DOI: 10.1007/s10147-019-01422-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/21/2019] [Indexed: 02/02/2023]
|
11
|
Tariq U, Sohail MS, Fatima Z, Khan A, Sheikh AB, Bhatti SI. Simultaneous Bilateral Spontaneous Pneumothorax: A Rare Complication of Osteosarcoma. Cureus 2018; 10:e2745. [PMID: 30087821 PMCID: PMC6075640 DOI: 10.7759/cureus.2745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The lungs are a common site of metastatic spread of an osteosarcoma. An affiliated simultaneous bilateral spontaneous pneumothorax (SBSP) is a rare clinical sequela of this malignancy. In this case report, we present the clinical circumstances of a young teenager who presented to our clinical setting following a diagnosis of osteosarcoma. We also illustrate the postulated pathophysiology, the tools for diagnosis and a subsequent management for this rare clinical entity.
Collapse
Affiliation(s)
- Usman Tariq
- Research Assistant, Yale University School of Medicine, New Haven, USA
| | | | - Zainab Fatima
- Medicine, Shifa International Hospital, Islamabad, PAK
| | - Amina Khan
- Shifa Tameer E Millat University, Shifa International Hospital, Islamabad, PAK
| | - Abu Baker Sheikh
- Internal Medicine, Shifa International Hospital, Islamabad, Select Country
| | | |
Collapse
|
12
|
Yevich S, Gaspar N, Tselikas L, Brugières L, Pacquement H, Schleiermacher G, Tabone MD, Pearson E, Canale S, Muret J, de Baere T, Deschamps F. Percutaneous Computed Tomography-Guided Thermal Ablation of Pulmonary Osteosarcoma Metastases in Children. Ann Surg Oncol 2015; 23:1380-6. [DOI: 10.1245/s10434-015-4988-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Indexed: 11/18/2022]
|
13
|
Treating metastatic sarcomas locally: A paradoxe, a rationale, an evidence? Crit Rev Oncol Hematol 2015; 95:62-77. [DOI: 10.1016/j.critrevonc.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/28/2014] [Accepted: 01/06/2015] [Indexed: 01/04/2023] Open
|
14
|
Metastasectomy of Pulmonary Metastases from Osteosarcoma: Prognostic Factors and Indication for Repeat Metastasectomy. ACTA ACUST UNITED AC 2015. [DOI: 10.1155/2015/570314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To identify prognostic factors for metastatic osteosarcoma patients and establish indication for repeat metastasectomy. Methods. Data from 37 patients with pulmonary metastasis from osteosarcoma who underwent metastasectomy in our institute from 1979 to 2013 were retrospectively reviewed. Results. Prognostic factors analyzed were age, sex, maximal diameter of the tumor at first pulmonary metastasectomy, total number of resected pulmonary metastases at first metastasectomy, number of surgeries, and disease free interval. In our analysis, characteristics associated with an increased overall survival were age > 15 years and fewer metastases (≤3). Of the 37 patients, 13 underwent repeat metastasectomy after the first metastasectomy. Of the 7 patients that underwent only two metastasectomies, three remained disease-free. In contrast, all six patients that underwent three or more metastasectomies died of relapse. Patients who had five or less lesions at second metastasectomy showed better survival compared to those who had six or more lesions. Conclusion. Age > 15 years and number of metastases at first metastasectomy were independent prognostic factors. Metastasectomy may provide curative treatment even in cases requiring repeat surgery. The number of metastases at second metastasectomy may be a potential predictor of the need for repeat surgery.
Collapse
|
15
|
Salah S, Toubasi S. Factors predicting survival following complete surgical remission of pulmonary metastasis in osteosarcoma. Mol Clin Oncol 2014; 3:157-162. [PMID: 25469287 DOI: 10.3892/mco.2014.426] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/12/2014] [Indexed: 11/06/2022] Open
Abstract
Pulmonary metastasectomy (PM) is associated with improved survival of patients with metastatic osteosarcoma; however, the factors affecting survival following achievement of complete surgical remission remain controversial. The main objective of this study was to report the outcomes and prognostic factors of osteosarcoma patients who achieved complete remission (CR) following PM. We analyzed the effect of demographic and disease-related characteristics on the overall survival (OS) of consecutive patients with metastatic osteosarcoma who were treated at a single institution and achieved CR following PM, through univariate and multivariate analyses. Between January, 2000 and August, 2013, 62 patients with metastatic osteosarcoma were treated and followed up at our institution. A total of 25 patients achieved CR following PM and were included in this analysis. The 5-year OS and disease-free survival following PM were 30 and 21%, respectively. The factors correlated with inferior OS in the univariate analysis included chondroblastic subtype, post-chemotherapy necrosis <90% in the primary tumor, metastasis detected during neoadjuvant or adjuvant chemotherapy and pathological identification of tumor cells reaching the visceral pleural surface of any of the resected nodules. In the multivariate analysis, the chondroblastic subtype was the sole independent adverse prognostic factor (HR=4.6, 95% CI: 1.0-21.3, P=0.044). Therefore, factors associated with tumor biology, including poor tumor necrosis in the primary tumor and detection of metastasis during primary chemotherapy, are associated with poor post-metastasectomy survival. In addition, chondroblastic subtype and visceral pleural involvement predicted poor prognosis in our series.
Collapse
Affiliation(s)
- Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Al-Jubeiha 11941, Amman, Jordan
| | - Samar Toubasi
- Department of Clinical Nursing, The University of Jordan, Al-Jubeiha 11942, Amman, Jordan
| |
Collapse
|
16
|
Nakada T, Okumura S, Kuroda H, Uehara H, Mun M, Sakao Y, Nakagawa K. Outcome of Radical Surgery for Pulmonary Metastatic Osteosarcoma with Secondary Spontaneous Pneumothorax: Case Series Report. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:574-7. [DOI: 10.5761/atcs.cr.12.02147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
17
|
Quality of Life Evolution after Pulmonary Metastasectomy: A Prospective Study Comparing Isolated Lung Perfusion with Standard Metastasectomy. J Thorac Oncol 2012; 7:1567-673. [DOI: 10.1097/jto.0b013e3182641d74] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
18
|
Pulmonary tuberculosis mimicking metastasis in a patient with osteosarcoma. J Pediatr Hematol Oncol 2012; 34:536-7. [PMID: 22935666 DOI: 10.1097/mph.0b013e318266bbd4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary metastasis even at diagnosis or during treatment is an important problem in osteosarcoma treatment and treatment modality varies in patients with metastasis. Metastasectomy and aggressive induction chemotherapy are the 2 most well-known treatment options. However, reactivation of pulmonary tuberculosis can be a problem in developing countries, where the prevalence of tuberculosis is high. Here, we described a patient with osteosarcoma with pulmonary tuberculosis reactivation mimicking metastasis.
Collapse
|
19
|
Mizuno T, Taniguchi T, Ishikawa Y, Kawaguchi K, Fukui T, Ishiguro F, Nakamura S, Yokoi K. Pulmonary metastasectomy for osteogenic and soft tissue sarcoma: who really benefits from surgical treatment? Eur J Cardiothorac Surg 2012; 43:795-9. [DOI: 10.1093/ejcts/ezs419] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Den Hengst WA, Hendriks JMH, Van Hoof T, Heytens K, Guetens G, de Boeck G, Lardon F, Van Schil PEY. Selective pulmonary artery perfusion with melphalan is equal to isolated lung perfusion but superior to intravenous melphalan for the treatment of sarcoma lung metastases in a rodent model. Eur J Cardiothorac Surg 2012; 42:341-7; discussion 347. [DOI: 10.1093/ejcts/ezs017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Treasure T, Fiorentino F, Scarci M, Møller H, Utley M. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012; 2:bmjopen-2012-001736. [PMID: 23048062 PMCID: PMC3488730 DOI: 10.1136/bmjopen-2012-001736] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Sarcoma has a predilection to metastasis to the lungs. Surgical excision of these metastases (pulmonary metastasectomy) when possible has become standard practice. We reviewed the published selection and outcome data. DESIGN Systematic review of published reports that include survival rates or any other outcome data. Survival data were put in the context of those in a cancer registry. SETTING Specialist thoracic surgical centres reporting the selection and outcome for pulmonary metastasectomy in 18 follow-up studies published 1991-2010. PARTICIPANTS Patients having one or more of 1357 pulmonary metastasectomy operations performed between 1980 and 2006. INTERVENTIONS All patients had surgical pulmonary metastasectomy. A first operation was reported in 1196 patients. Of 1357 patients, 43% had subsequent metastasectomy, some having 10 or more thoracotomies. Three studies were confined to patients having repeated pulmonary metastasectomy. PRIMARY AND SECONDARY OUTCOME MEASURES Survival data to various time points usually 5 years and sometimes 3 or 10 years. No symptomatic or quality of life data were reported. RESULTS About 34% and 25% of patients were alive 5 years after a first metastasectomy operation for bone or soft tissues sarcoma respectively. Better survival was reported with fewer metastases and longer intervals between diagnosis and the appearance of metastases. In the Thames Cancer Registry for 1985-1994 and 1995-2004 5 year survival rates for all patients with metastatic sarcoma were 20% and 25% for bone, and for soft tissue sarcoma 13% and 15%. CONCLUSIONS The 5 year survival rate among sarcoma patients who are selected to have pulmonary metastasectomy is higher than that observed among unselected registry data for patients with any metastatic disease at diagnosis. There is no evidence that survival difference is attributable to metastasectomy. No data were found on respiratory or any other symptomatic benefit. Given the certain harm associated with thoracotomy, often repeated, better evidence is required.
Collapse
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics, UCL , London, UK
| | - Francesca Fiorentino
- National Heart and Lung Institute, Cardiothoracic Surgery, Imperial College London, London, UK
| | - Marco Scarci
- Department of Thoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Henrik Møller
- Thames Cancer Registry, King's College London, London, UK
| | - Martin Utley
- Clinical Operational Research Unit, Department of Mathematics, UCL , London, UK
| |
Collapse
|
22
|
Pulmonary metastases in children with osteosarcoma: characteristics and impact on patient survival. Pediatr Radiol 2011; 41:227-36. [PMID: 20814672 DOI: 10.1007/s00247-010-1809-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 07/19/2010] [Accepted: 07/19/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 15-20% of patients with osteosarcoma present with detectable metastatic disease and the majority of whom (85%) have pulmonary lesions as the sole site of metastasis. Previous studies have shown that the overall survival rate among patients with localized osteosarcoma without metastatic disease is approximately 60-70% whereas survival rate reduces to 10-30% in patients with metastatic disease. OBJECTIVE To determine the incidence and characteristic features of pulmonary metastases in a group of osteosarcoma patients and correlate the findings with the prognostic outcome/survival. MATERIALS AND METHODS Seventy-seven cases of histologically confirmed osteosarcoma were reviewed (47 male, 30 female, mean age 10.9). The site and size of the primary tumour and degrees of chemonecrosis were recorded. Lung metastases were analyzed according to their size, number, distribution and interval from diagnosis. The Kaplan-Meier method was used to analyze the survival probability curve. Significant differences (P < 0.05) were evaluated with the log-rank test for univariate analyses. RESULTS Seventeen patients had synchronous and 11 had metachronous lung metastases. Sixteen (57%) underwent pulmonary metastasectomy. Nine of sixteen (56%) patients with metastasectomy and 10/12 (83%) patients without metastasectomy died. Poor chemonecrosis was associated with a worse outcome. Number, distribution and timing of lung metastases, but not the size of lung metastases, were of prognostic value for survival. CONCLUSION Radiological detection of lung metastases is clinically important as it indicates a worse prognosis.
Collapse
|