Patients with osteosarcoma with a single pulmonary nodule on computed tomography: a single-institution experience.
OBJECTIVE
The purpose of this study is to determine if patients with osteosarcoma (OS) with metachronous metastatic pulmonary disease presenting with a single pulmonary nodule (SPN) on computed tomography (CT) were found to have other lesions at the time of thoracotomy.


METHODS
Data were collected retrospectively on consecutive patients with OS treated at our institution from 1982 to 2007. Patients with no evidence of disease at the end of initial therapy who subsequently relapsed in the lung were identified.


RESULTS
In our study, 16 (8%) of 198 patients with OS with metachronous metastatic pulmonary disease presented with a SPN on CT scan. In all patients, only 1 metastatic nodule for OS was found at the time of thoracotomy. The median time between diagnosis and first lung relapse was 23.8 months (range, 4-80 months). Eleven patients (68.7%) subsequently had a second lung relapse, but only 3 patients had involvement of the ipsilateral lung (mean time interval between first and second pulmonary relapses of 17 months; range, 2-44 months). Five-year overall survival from diagnosis was 56.2%. Seven patients (43.8%) died of disease progression.


CONCLUSIONS
In our experience, patients with OS with metachronous metastatic pulmonary disease presenting with a SPN on CT were not found to have additional malignant lesions at the time of thoracotomy. Consideration should be given in this group of selected patients to use a minimally invasive approach to nodule removal with image-guided localization, if needed, rather than open thoracotomy because ipsilateral metastases are not likely to be found.
Department of Surgery, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
Israel
I
Fernandez-Pineda
Najat C
NC
Daw
Beth
B
McCarville
Liza J
LJ
Emanus
Bhaskar N
BN
Rao
Andrew M
AM
Davidoff
Stephen J
SJ
Shochat
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies; D016879:Salvage Therapy; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000601:surgery; D013714:Tennessee / Q000453:epidemiology; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D036542:Tomography, Spiral Computed; D019564:Unnecessary Procedures; D055815:Young Adult