title: High grade osteosarcoma of the extremities metastatic to the lung: long-term results in 323 patients treated combining surgery and chemotherapy, 1985-2005.
abstract: BACKGROUND
  Approximately one-third of patients with localized osteosarcoma at presentation relapse as well as about three-fourths of the patients with metastases at diagnosis, about 90% of relapses are lung metastases. The role of lung metastasectomy remains to be determined.
  
  
  METHODS
  and methods: Three hundred and twenty three patients, 88 with resectable lung metastases at diagnosis and 235 with localized disease at presentation who relapsed with lung metastases were treated.
  
  
  RESULTS
  A total of 498 lung surgeries and 607 thoracotomies were performed. The 5 year overall survival was 37%. Final outcome was significantly related to presence or absence of metastasis, time of first relapse and presence of local recurrences. According to stage of the disease, the rate of a 5 year event-free survival (EFS) was 36% for patients with localized disease who later relapsed and 9% for patients with resectable lung metastases at presentation (p<0.0001). However, there were no differences in EFS between patients who underwent two or three thoracotomies and patients who had four or five thoracotomies (7.5 vs 18.7%, p=0.29).
  
  
  CONCLUSIONS
  In patients with recurrent resectable pulmonary metastases from high grade osteosarcoma treated with adjuvant or neoadjuvant chemotherapy, thoracotomy should always be considered regardless the number of previous lung relapses and the number of secondary pulmonary lesions.
authors.affiliation: General Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy.
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 Antonio
authors.initials: GA
authors.lastname: Guzzardella
authors.forename: Alba
authors.initials: A
authors.lastname: Balladelli
authors.forename: Gaetano
authors.initials: G
authors.lastname: Bacci
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D005121:Extremities; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012516:Osteosarcoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D013908:Thoracotomy; D016896:Treatment Outcome; D055815:Young Adult