What are the treatment options for osteosarcoma with lung metastases (mets)?

From the Guidelines

Treatment for osteosarcoma lung metastases should involve a multidisciplinary approach combining chemotherapy, surgery, and sometimes radiation therapy, with surgical resection of all detectable metastatic nodules recommended when feasible, as complete resection significantly improves survival rates, as stated in the most recent guidelines 1. The standard chemotherapy regimen for osteosarcoma includes high-dose methotrexate, doxorubicin, and cisplatin administered over several cycles before and after surgery.

• For lung metastases specifically, surgical resection of all detectable metastatic nodules is recommended when feasible, as complete resection significantly improves survival rates.
• This may involve wedge resections, lobectomies, or even bilateral thoracotomies depending on the extent and location of metastases.
• Patients with unresectable metastases may benefit from second-line chemotherapy agents such as ifosfamide with etoposide or gemcitabine with docetaxel.
• The 5-year survival rate for patients with lung metastases ranges from 20-40% when complete surgical resection is achieved, but drops significantly when metastases cannot be completely removed, as supported by previous studies 1. Regular follow-up with chest CT scans every 3-4 months for the first two years is essential for early detection of recurrence or new metastases.
• The primary tumour should be resected with negative surgical margins where feasible, and adjuvant radiotherapy is not recommended routinely after surgery, as per the latest guidelines 1.
• If surgical removal is not possible, radiotherapy can be used to achieve local tumour control, and excision of pulmonary metastases if possible, may prolong survival.
• Recurrent disease should be resected, if possible, and both chemotherapy and MTKIs may have a role, as suggested by recent studies 1.

From the Research

Treatment Options for Osteosarcoma with Lung Metastases

• The treatment options for osteosarcoma with lung metastases include chemotherapy, surgery, and radiotherapy 2.
• Standard chemotherapy for osteosarcoma metastatic at presentation is based on high-dose methotrexate, doxorubicin, and cisplatin (the MAP regimen), with the possible addition of ifosfamide 2.
• Surgical treatment continues to be fundamental, with complete surgical resection of all sites of disease (primary and metastatic) remaining essential for survival 2.
• Advanced radiotherapy techniques, such as carbon ion radiotherapy and stereotactic radiosurgery, and molecular targeted chemotherapy with drugs such as pazopanib or apatinib have improved the prognosis, especially for patients who are medically inoperable or who refuse surgery 2.

Role of Chemotherapy and Surgery

• Chemotherapy can be effective in treating osteosarcoma with lung metastases, with a study showing that 12 out of 19 patients who had a complete simultaneous resection of the primary and metastatic tumor had a strong correlation between the degree of necrosis of the primary and metastatic lesions 3.
• Surgery is also an important part of the treatment, with a study showing that patients who underwent surgical removal of the lung metastases had a 5-year overall survival rate of 29% 4.
• The combination of chemotherapy and surgery can be effective, with a study showing that patients who had a good response to chemotherapy had a better prognosis, with a 5-year overall survival rate of 53% 4.

Prognostic Factors

• The presence of metastatic disease at diagnosis is a poor prognostic factor 2.
• The number of lung metastases is also a prognostic factor, with patients who have only one or two metastatic lesions having a better prognosis than those with three or more lesions 3.
• The response to chemotherapy is also an important prognostic factor, with patients who have a good response to chemotherapy having a better prognosis 4.