title: Resection of recurrent pulmonary metastases in patients with osteosarcoma.
abstract: BACKGROUND
  Surgical resection of lung metastases is widely accepted in osteosarcoma patients. Few data exist on treatment of recurrent pulmonary metastases. The authors of the current study retrospectively analyzed patients with osteosarcoma who received surgery for recurrent lung metastases.
  
  
  METHODS
  From 1980 to 2001, 127 metastasectomies were performed on 94 patients. Criteria of eligibility were no metastases beyond the lung, no local recurrence, possibility of achieving complete resection of metastases without causing respiratory insufficiency, acceptable operative risk. Data were statistically elaborated with survival analysis according to Kaplan-Meier method of univariate analysis, life tables and Gehan statistic model, and multivariate analysis using Cox regression test. Results were considered in terms of time from first (DFI1) and second (DFI2) metastasectomy.
  
  
  RESULTS
  Of 94 patients operated upon twice, 59 (62.7%) died. Thirty-five (37.3%) are alive; 31 (32.9%) of these are continuously disease-free. The 3- and 5-year event-free actuarial survival curve from first metastasectomy was 45%, and 38%, respectively, whereas from the second metastasectomy, it was 33% and 32%, respectively. According to a Cox regression model, DFI1 has a risk of death of 0.974 times and DFI2 of 0.972 times for every additional month of survival. In multivariate analysis, Cox regression test showed the best predictive model of local recurrence and number of metastases (P = 0.0014).
  
  
  CONCLUSIONS
  The authors concluded that patients persistently free of the primary osteosarcoma who developed recurrent resectable metastatic disease of the lung should be considered for reoperation a second, third, or fourth time, as these patients had similar DFI curves after five-years.
authors.affiliation: General Surgery, Rizzoli Orthopedic Institute, Bologna, Italy. antonio.briccoli@ior.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Briccoli
authors.forename: Michele
authors.initials: M
authors.lastname: Rocca
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Salone
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Alba
authors.initials: A
authors.lastname: Balladelli
authors.forename: Mario
authors.initials: M
authors.lastname: Mercuri
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012516:Osteosarcoma / Q000556:secondary* / Q000601:surgery*; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome