OSTEOSARCOMA AND PULMONARY METASTASES - 15-YEAR EXPERIENCE FROM A SINGLE INSTITUTION

Background: The outcome of management in patients with osteosarcoma an d pulmonary metastases at a Sydney teaching hospital was reviewed. Met hods: A retrospective review was undertaken of all patients diagnosed with osteosarcoma and treated by the Bone and Soft Tissue Unit and the Medical Oncology Department, Royal Prince Alfred Hospital between 197 9 and January 1995. Information was collected on demographics, tumour site, tumour histology, primary management including surgery and adjuv ant therapy, and the subsequent development and management of pulmonar y metastases. Results: A total of 56 patients with localized osteosarc oma was seen. Overall survival and survival following pulmonary metast ases with assessed. There were 33 (59%) males and 23 (41%) females, wi th a median age of 27 years. Survival at 5 years, for patients with no n-axial osteosarcoma was 60% (95% CI, 44-77%). Pulmonary metastases wi thout other metastatic disease being apparent, developed in 22, patien ts, of whom 12 underwent surgical resection. The median disease-free i nterval of these latter patients was 20 months (95% CI, 8-32 months). Median survival among patients not undergoing surgical resection was 5 months from detection of metastases. Patients undergoing resection of pulmonary metastases had a median survival of 17 months following det ection of pulmonary metastases (95% CI, 7-27 months). Actuarial 5-year survival was 16% (95% CI, 0-42%). Conclusions: A small proportion of patients with resectable pulmonary metastases from osteosarcoma achiev e long-term disease-free survival following surgical resection. It is not possible to accurately identify these patients prospectively.