Abstract
BACKGROUND
Surgical resection of lung metastases is widely accepted in osteosarcoma patients. Few data exist on treatment of recurrent pulmonary metastases. The authors of the current study retrospectively analyzed patients with osteosarcoma who received surgery for recurrent lung metastases.
METHODS
From 1980 to 2001, 127 metastasectomies were performed on 94 patients. Criteria of eligibility were no metastases beyond the lung, no local recurrence, possibility of achieving complete resection of metastases without causing respiratory insufficiency, acceptable operative risk. Data were statistically elaborated with survival analysis according to KaplanβMeier method of univariate analysis, life tables and Gehan statistic model, and multivariate analysis using Cox regression test. Results were considered in terms of time from first (DFI^1^) and second (DFI^2^) metastasectomy.
RESULTS
Of 94 patients operated upon twice, 59 (62.7%) died. Thirtyβfive (37.3%) are alive; 31 (32.9%) of these are continuously diseaseβfree. The 3β and 5βyear eventβfree actuarial survival curve from first metastasectomy was 45%, and 38%, respectively, whereas from the second metastasectomy, it was 33% and 32%, respectively. According to a Cox regression model, DFI^1^ has a risk of death of 0.974 times and DFI^2^ of 0.972 times for every additional month of survival. In multivariate analysis, Cox regression test showed the best predictive model of local recurrence and number of metastases (P = 0.0014).
CONCLUSIONS
The authors concluded that patients persistently free of the primary osteosarcoma who developed recurrent resectable metastatic disease of the lung should be considered for reoperation a second, third, or fourth time, as these patients had similar DFI curves after fiveβyears. Cancer 2005. Β© 2005 American Cancer Society.