Treatment of osteosarcoma patients with pulmonary metastasis

Abstract

The lung is the most common site of relapse from osteosarcoma. Several studies revealed that the patients with pulmonary metastases of osteosarcoma have a poor prognosis. This article aims to describe the current understanding of the characteristics, prognostic factors, and the local treatment strategy for pulmonary metastases of osteosarcoma. Several clinical characteristics, such as a number or laterality of pulmonary nodules, location, or time interval from initial treatment, have been reported as potential prognostic factors for the patients with pulmonary metastases. Meanwhile, outcome of the patients with pulmonary metastases at initial presentation is not a dismal when the appropriate chemotherapy and thoracotomy are performed. As a treatment factor, complete surgical resection of the pulmonary metastases is a most important predictor for survival of those patients, although the benefit of video-assisted thoracoscopic surgery or multiple thoracotomy is still controversial. The number of published data available regarding the efficacy of radiotherapy in the treatment of pulmonary metastases is limited. Emerging techniques including stereotactic body radiotherapy and radiofrequency ablation could be an effective option of the treatment for unresectable metastatic lesion.