title: Surgical management and outcome of osteosarcoma patients with unilateral pulmonary metastases.
abstract: OBJECTIVE
  The surgical management of osteosarcoma patients with unilateral pulmonary nodules is controversial. The authors reviewed their institutional experience to evaluate the incidence of occult contralateral metastases.
  
  
  METHODS
  Data were obtained retrospectively on all consecutive osteosarcoma patients from 1980 to 2002. Eighty-four patients with pulmonary nodules were identified. Forty-one had bilateral disease, and 43 had unilateral involvement by computed tomography (CT) scan.
  
  
  RESULTS
  All 43 patients with unilateral nodules underwent ipsilateral thoracotomies. Fifteen patients had negative exploration findings, and only 1 had pulmonary relapse. Of the 28 patients with metastases confirmed at initial thoracotomies, 14 had extensive pleural or extrapulmonary disease at initial thoracotomy followed by disease progression. The other 14 are separated into early versus late metastases, using 2 years from diagnosis as the cutoff point. Seven of the 9 (78%) patients with early metastases had or subsequently had contralateral disease; 6 were identified at staged contralateral thoracotomy and 1 had relapsed in the unexplored lung a year later. Only 1 of the 5 patients with late unilateral metastases had relapse in the contralateral side.
  
  
  CONCLUSIONS
  Our data indicate that there is a high rate of contralateral involvement in osteosarcoma patients with unilateral nodules diagnosed by CT scan. Staged bilateral thoracotomies should be considered in osteosarcoma patients presenting with unilateral pulmonary disease on imaging studies within 2 years of diagnosis.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Wendy T
authors.initials: WT
authors.lastname: Su
authors.forename: Joseph
authors.initials: J
authors.lastname: Chewning
authors.forename: Sara
authors.initials: S
authors.lastname: Abramson
authors.forename: Nancy
authors.initials: N
authors.lastname: Rosen
authors.forename: Maryam
authors.initials: M
authors.lastname: Gholizadeh
authors.forename: John
authors.initials: J
authors.lastname: Healey
authors.forename: Paul
authors.initials: P
authors.lastname: Meyers
authors.forename: Michael P
authors.initials: MP
authors.lastname: La Quaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D012516:Osteosarcoma / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed