title: Successful management of a widespread osteosarcoma. A case report.
abstract: OBJECTIVE
  To report the case of a 23-year-old woman with widespread osteosarcoma including skeletal, pulmonary and pleural metastases, who had a remarkable response to combined chemo- and radiotherapy.
  
  
  METHODS
  A 23-year-old Indonesian woman presented in October 1999 with a swelling of the right thigh, severe generalized pain and progressive left hemiparesis. Radiological examination revealed osteolytic lesions in the cervical spine. CT scan of the chest showed multiple pulmonary metastases and a huge left pleural effusion. Bone scan with technetium-99m hydroxymethylene diphosphonate showed intense uptake of the radiopharmaceutical in the distal right femur, generalized deposits throughout the skeleton and in the right hemithorax corresponding to the lung findings. Bone marrow and kidney function tests as well as serum calcium level were normal. Alkaline phosphatase was markedly elevated, 8,000 IU/l (normal <250 IU/l). Histopathology from the femoral tumor showed osteosarcoma. Treatment was started with radiotherapy to the cervical spine followed immediately by a combination chemotherapy with ifosfamide, cisplatin, etoposide and mesna rescue. In addition, the patient received bisphosphonates regularly. Eleven cycles of chemotherapy were given with a remarkable response.
  
  
  CONCLUSIONS
  The patient was successfully treated with a combination of radio- and chemotherapy. She recovered fully and is in almost complete remission. The disease remained stable 24 months after the discontinuation of the treatment.
authors.affiliation: Department of Nuclear Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: Pentti
authors.initials: P
authors.lastname: Grohn
authors.forename: Ashok
authors.initials: A
authors.lastname: Uttamchandani
authors.forename: Zuhair
authors.initials: Z
authors.lastname: Al-Haider
authors.forename: Bruce
authors.initials: B
authors.lastname: Adams
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000532:radiotherapy*; D011859:Radiography; D012074:Remission Induction
chemical_list: D005047:Etoposide; D002945:Cisplatin; D007069:Ifosfamide