[Non-metastatic osteosarcoma of the extremities: the pattern of relapse as a function of the type of treatment and of the modulation of the radiological follow-up of the thorax].
The authors analysed the patterns of recurrence of osteosarcoma of the extremities treated between 1959 and 1989 either with surgery alone (1959-71) or with combined surgery and adjuvant (1972-82) or neoadjuvant chemotherapy (1983-89). In a total of 452 patients with recurrent osteosarcoma, the initial site of metastasis was the lung in 88% of cases independently of the type of treatment received. The mean period of onset of pulmonary metastasis differed according to the type of treatment performed: 8 months for patients treated with surgery alone; 15.9 months for those treated with adjuvant chemotherapy and 20.3 months for patients treated with neoadjuvant chemotherapy. The incidence of metastases appearing within 12 months of FU was 87%, 56% and 21% respectively. In a most recent and effective neoadjuvant protocol (66% DFS), the incidence of recurrence owing to pulmonary metastasis during the first year of FU was 2% and as much as 75% of all recurrences were concentrated in the following 18 months. Surgery for pulmonary metastasis in patients undergoing chemotherapy was performed in 54 cases with secondary healing in 14 (26%). On the basis of these results the authors suggest a scheme of radiological follow-up for patients with osteosarcoma of the extremities treated with neoadjuvant chemotherapy with intensified controls (every 2 months) during the period with the highest risk of recurrence (13-20 months) and four-monthly controls during the first year and after 31 months of FU. In order to increase the efficacy of FU controls during the high-risk period, the a. propose using CT controls instead of chest X-rays at months 14, 20 and 26.
Rimondi
E
E
Servizio di Radiologia, Istituto Rizzoli, Bologna.
Ferrari
S
S
Briccoli
A
A
Iantorno
D
D
Forni
C
C
Bacci
G
G
D000328:Adult; D001132:Arm; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007866:Leg; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D013902:Radiography, Thoracic; D012307:Risk Factors; D013997:Time Factors