title: Variability in the reported management of pulmonary metastases in osteosarcoma.
abstract: Nearly 20% of patients with newly diagnosed osteosarcoma have detectable metastases at diagnosis; the majority of which occur in the lungs. There are no established recommendations for the timing and modality of metastasectomy. Members of the Connective Tissue Oncology Society (CTOS) were emailed an anonymous 10-min survey assessing their management practices for pulmonary findings at the time of an osteosarcoma diagnosis. The questionnaire presented three scenarios and discussed the choice to perform surgery, the timing of resection, and the choice of surgical procedure. Analyses were stratified by medical profession. One hundred and eighty-three physicians responded to our questionnaire. Respondents were comprised of orthopedic surgeons (37%), medical oncologists (31%), pediatric oncologists (22%), and other medical subspecialties (10%). There was variability among the respondents in the management of the pulmonary nodules. The majority of physicians chose to resect the pulmonary nodules following neoadjuvant chemotherapy (46-63%). Thoracotomy was the preferred technique for surgical resection. When only unilateral findings were present, the majority of physicians did not explore the contralateral lung. The majority of respondents did not recommend resection if the pulmonary nodule disappeared following chemotherapy. The survey demonstrated heterogeneity in the management of pulmonary metastases in osteosarcoma. Prospective trials need to evaluate whether these differences in management have implications for outcomes for patients with metastatic osteosarcoma.
authors: Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
authors: Onita
authors: O
authors: Bhattasali
authors: Andrea T
authors: AT
authors: Vo
authors: Michael
authors: M
authors: Roth
authors: David
authors: D
authors: Geller
authors: R Lor
authors: RL
authors: Randall
authors: Richard
authors: R
authors: Gorlick
authors: Jonathan
authors: J
authors: Gill
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008511:Medicine / Q000706:statistics & numerical data; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D012516:Osteosarcoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data
keywords: Osteosarcoma; practice patterns; pulmonary metastases
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