From the Guidelines
The survival rate for osteosarcoma with lung metastases in Australia is approximately 20-30% at 5 years, with complete surgical remission achievable in around 30% of patients with primary metastatic osteosarcoma, and over 40% of those who achieve complete surgical remission becoming long-term survivors 1.
Overview of Osteosarcoma with Lung Metastases
Osteosarcoma typically spreads to the lungs through hematogenous dissemination, where cancer cells enter the bloodstream and establish secondary tumors in lung tissue. The underlying mechanism involves the cancer cells' ability to invade blood vessels, survive in the bloodstream, and colonize distant organs, including the lungs.
Treatment Approach
Treatment typically involves a multimodal approach including:
- Neoadjuvant chemotherapy (commonly using methotrexate, doxorubicin, and cisplatin) to facilitate local surgical treatment and allow assessment of tumor response 1
- Surgical resection of both the primary tumor and lung metastases when possible, with the goal of obtaining adequate surgical margins and preserving as much function as possible 1
- Adjuvant chemotherapy to eliminate any remaining cancer cells
Prognostic Factors
Prognostic factors include:
- The number and location of lung nodules
- Time to metastasis development
- Response to chemotherapy, with the extent of histological response to preoperative chemotherapy predicting survival 1 Patients with fewer nodules, longer interval to metastasis development, and good histologic response to chemotherapy have better outcomes.
Follow-up and Recurrence
Regular follow-up with chest imaging every 3-4 months for the first two years is essential for early detection of recurrence. Complete removal of all metastases must be attempted, as the disease is otherwise almost universally fatal, while more than a third of patients with a second surgical remission survive for >5 years 1.
From the Research
Survival Rate and Prognosis of Osteosarcoma with Lung Metastases
- The 2-year disease-free survival (DFS) and overall survival (OS) for patients with osteosarcoma and lung metastases were 36% and 53%, respectively 2.
- The 5-year overall survival rate for patients with osteosarcoma and lung metastases was around 29% 3.
- Patients with good response to chemotherapy had a better prognosis, with a 5-year overall survival rate of 53% compared to 8% for those with poor response 3.
- The presence of unilateral lung metastases, no more than three lung nodules, and surgical remission were associated with improved survival probability 4.
Underlying Mechanism
- The strong correlation between the degree of necrosis of the primary and metastatic lesions supports the strategy of tailoring postoperative chemotherapy based on the primary tumor histologic response to preoperative chemotherapy 2.
- The expression of p-glycoprotein and topoisomerase-II was correlated with the therapeutic effect of pirarubicin-based chemotherapy in osteosarcoma patients with lung metastasis 5.
- The use of aggressive chemotherapy with simultaneous resection of primary and metastatic tumors can be effective for patients with osteosarcoma and lung metastases, especially those with one or two metastatic nodules 2.
Treatment Options
- Neoadjuvant chemotherapy with cisplatin, adriamycin, and high-dose methotrexate and ifosfamide, followed by simultaneous resection of primary and metastatic lesions, can be an effective treatment option for patients with osteosarcoma and lung metastases 2.
- Pirarubicin-based chemotherapy regimens can be safe and effective as a salvage chemotherapy option for osteosarcoma patients with secondary lung metastasis 5.
- Carboplatin-based multiagent chemotherapy can be used to treat patients with metastatic osteosarcoma, although the outcome may be poor 4.