title: Long-term survival after central nervous system relapse in a patient with osteosarcoma.
abstract: BACKGROUND
  Since the advent of multiagent adjuvant chemotherapy, survival among patients with localized osteosarcoma has improved to 60% or more. Pulmonary relapse, the most common cause of treatment failure, is associated with less than 25% long-term survival; central nervous system (CNS) metastasis, when it occurs, often presents as a catastrophic clinical event in preterminal patients.
  
  
  METHODS
  The authors report a patient with osteosarcoma who had an isolated pulmonary relapse and a subsequent isolated CNS relapse. Complete surgical resection was accomplished on both occasions and followed in the initial instance by adjuvant chemotherapy and in the latter instance by adjuvant whole-brain irradiation.
  
  
  RESULTS
  An isolated CNS metastasis was resected and adjuvant whole brain irradiation was administered; the patient is alive and relapse free more than 5 years later.
  
  
  CONCLUSIONS
  Patients with osteosarcoma in whom isolated, resectable metastases develop can derive benefit from gross total resection followed by adjuvant chemotherapy or radiation therapy for microscopic residual disease.
authors.affiliation: Pediatric Branch, National Cancer Institute, Bethesda, MD 20892.
authors.forename: L H
authors.initials: LH
authors.lastname: Wexler
authors.forename: T F
authors.initials: TF
authors.lastname: DeLaney
authors.forename: S
authors.initials: S
authors.lastname: Saris
authors.forename: M E
authors.initials: ME
authors.lastname: Horowitz
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005266:Femoral Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D013997:Time Factors