PULMONARY RESECTION IN CHILDREN WITH METASTATIC OSTEOGENIC-SARCOMA - IMPROVED SURVIVAL WITH SURGERY, CHEMOTHERAPY, AND IRRADIATION

Abstract

Consecutive unselected patients (12, aged 6-18) with osteogenic sarcoma underwent 19 thoracotomies for resection of pulmonary metastases. Wedge excisions of 41 metastatic nodules, 1 bilobectomy and 1 pneumonectomy were performed. Patients (6) each required 1 thoracotomy, 5 patients underwent 3 thoracotomies and 1 patient required triple thoracotomy. Serious surgical complications were limited to 1 patient who required reoperation for closure of a bronchopleural fistula following bilobectomy. Initial pulmonary metastasis occurred 9 mo. (mean) after amputation (range 1-21 mo.). Complete excision of all identifiable metastatic tumor was possible in 17 of 19 thoracotomies. All patients received intensive cyclical chemotherapy after initial definitive amputation, after thoracotomy, or both. Tumor doubling time (TDT) during chemotherapy (mean 74 days) was significantly prolonged (P = 0.017) compared to TDT during intervals of no therapy (mean 22 days). Patients (5) received pulmonary radiotherapy prior to thoracotomy and 5 after thoracotomy. Patients (4) died during the observation period, having survived 10-30 mo. after amputation. Patients (2) are alive with known extrapulmonary metastases. Patients (6) are free of disease. The survival rate is 91.7% 1 yr after amputation, 82.5% at 2 yr and 57.8% at 3 yr. These results suggest improved survival when aggressive surgical resections of pulmonary metastases are combined with chemotherapy and radiotherapy. Thoracic surgical procedures in this group of patients are safe and associated with a low incidence of complications despite the potentially increased risks owing to antecedent chemotherapy and pulmonary irradiation.