Multimodal treatment of osteosarcoma lung metastases.
OBJECTIVE
The diagnostic procedures, role of surgery and multimodal treatment for osteosarcoma pulmonary metastases are examined.


METHODS
From January 2000 to June 2005, we observed 35 patients with osteogenic repetitions. Patients were studied by total-body computerised tomography (CT) and by thoracic single-photon emission computerised tomography (SPECT). Preoperative histological diagnosis was obtained by CT-guided transthoracic needle biopsy (23 cases) and fibre-optic bronchoscopy (12 cases).


RESULTS
Four lower, 6 upper and 2 middle lobectomies were carried out using a thoracotomy approach. Video-assisted thoracoscopy was used in the other 23 patients who underwent 36 wedge resections. CT showed a sensitivity of 86 % and a specificity of 66 %; SPECT had a sensitivity of 80 % and a specificity of 100 %. Twenty-five patients are still living 25 +/- 11 months after the intervention.


CONCLUSIONS
SPECT was demonstrated to offer a better result in the individualisation of secondary pulmonary nodules after primary osteosarcoma. The excision of all resectable lung metastases, integrated in a multidisciplinary strategy, offers good results in terms of survival.
Divisi
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D
Department of Thoracic Surgery, University of L'Aquila, G. Mazzini Hospital, Circonvallazione Ragusa 39, 64100 Teramo, Italy. duilio.divisi@virgilio.it
Gizzonio
D
D
Crisci
R
R
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D001999:Bronchoscopy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D012680:Sensitivity and Specificity; D013906:Thoracoscopy; D013907:Thoracostomy; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000970:Antineoplastic Agents