title: Location of pulmonary metastasis in pediatric osteosarcoma is predictive of outcome.
abstract: BACKGROUND
  The 3-year survival after pulmonary metastasectomy for osteosarcoma (OS) is approximately 30%. Resection of metastatic disease can prolong life in pediatric patients with OS. Our objective is to assess the outcome of pediatric patients with pulmonary metastases located centrally as compared with peripheral lesions.
  
  
  METHODS
  A retrospective review of patients 0 to 21 years old with a diagnosis of OS with pulmonary metastases on computed tomographic scan between 1985 and 2000 was completed. Demographics, metastasis location, survival, morbidity, and mortality were evaluated.
  
  
  RESULTS
  Of 115 patients who had pulmonary metastasis secondary to OS, there were 96 wedge resections and 13 lobectomy/pneumonectomies in 84 patients. The morbidity of wedge resection was 9% and lobectomy/pneumonectomy was 8%. There were no deaths from surgery. The median survival for patients undergoing lobectomy compared with wedge resection was 0.61 and 1.14 years, respectively, but did not reach statistical significance. The median overall survival for the entire cohort was 0.75 years. The median overall survival after initial detection of metastatic disease was 1.06 years among the patients with peripheral disease, compared with 0.38 years in patients with central disease (P = .008).
  
  
  CONCLUSIONS
  Patients with central pulmonary metastases in OS have a very poor prognosis, even after operative treatment, compared with those with peripheral disease. Patients with central lesions may benefit from other nonsurgical treatment options.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, Houston, TX 77030, USA.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Letourneau
authors.forename: Lianchun
authors.initials: L
authors.lastname: Xiao
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Harting
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.forename: Charles S
authors.initials: CS
authors.lastname: Cox
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Andrassy
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Hayes-Jordan
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D009928:Organ Specificity; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013908:Thoracotomy; D016896:Treatment Outcome; D055815:Young Adult