Faculty Opinions recommendation of Effect of concurrent metastatic disease on survival in children and adolescents undergoing lung resection for metastatic osteosarcoma.

Resection of pulmonary metastases has achieved a central role in the overall management of osteosarcoma, since a number of studies have demonstrated that salvage surgery is able to cure 20 to 40% of all relapsing patients. This paper presents the results of surgical management of 27 consecutive cases of pulmonary metastases from osteosarcoma, who underwent complete resection at the Istituto Nazionale Tumori of Milan between 1975 and 1986. In the present series, overall actuarial survival at 3 years from the first thoracotomy was 47%, with a median survival of 28 months and no operative mortality. Better results were observed in patients with single lesions (68% survival) or when the interval to lung metastases exceeded 12 months (60% survival). These data support the concept of pulmonary metastasectomy as effective salvage therapy for metastatic osteosarcomas whose distant spread is confined in the lungs.

Download Full-text

Survival for patients with resectable lung metastatic colorectal cancer (mCRC).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.708 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 708-708

Author(s):

Timothy Jay Price ◽

Yoko Tomita ◽

Carol Beeke ◽

Robert Padbury ◽

Amanda Rose Townsend ◽

...

Keyword(s):

Overall Survival ◽

Liver Resection ◽

Metastatic Disease ◽

Statistical Significance ◽

Lung Resection ◽

Standard Of Care ◽

Patient Characteristics ◽

Term Survival ◽

Lower Hazard

708 Background: Hepatic resection for CRC metastasis is now considered a standard of care and perioperative chemotherapy may improve outcomes. Resection of metastasis isolated to lung is also considered potentially curable, although there is still some variation in recommendations and no evidence for perioperative or adjuvant chemotherapy. Here, we explore patient characteristics and outcomes for patients undergoing lung resection for mCRC, with the liver resection group as the comparator. Methods: SA mCRC registry data were analysed to assess patient characteristics and survival outcomes between patients suitable for lung or liver resection. K-M survival analysis was used to assess OS. Results: 3,241 patient are registered on the database. 102 (3.1%) patients were able to undergo a lung resection compared to 420 (12.9%) a liver resection. Of the lung resection patients, 21% initially presented with liver only disease, 11% both lung and liver, and 7% brain or pelvic disease. 62 (61%) presented with lung only disease. Of these patients, 79% went straight to surgery and 34% had lung resection as the only intervention. When comparing the groups, they were balanced for age and sex, liver v lung; 67.7 years v 69.5 years, 63.6% v 57.8% male. There was no difference in pathological grade or KRAS MT rate when tested (36% liver v 32% lung). Compared to patients undergoing liver resection, those having lung resection were more likely to be metachronous (75.5% v 44%, p=<0.0001) and have a rectal primary (43.1% v 30.7%, p=0.017). Chemotherapy for metastatic disease was given more often in liver resection patients (76.9% v 53.9%, p=0.17). Median overall survival is not reached for both arms and the lower hazard rate for lung than liver resection does not approach statistical significance (HR 0.82, 95% CI 0.54-1.24, p=0.33). The 3 and 5 year survival liver v lung as follows; 77% v 81% and 62% v 70%. Conclusions: Lung resection occurs less frequently than liver resection for metastatic disease as expected. There was no statistical difference in overall survival in patients suitable for lung or liver resection. These data support the potential for long term survival with resection of both lung and liver metastasis in mCRC.

Download Full-text

Upfront window trial of topotecan in previously untreated children and adolescents with poor prognosis metastatic osteosarcoma

Cancer ◽

10.1002/cncr.22553 ◽

2007 ◽

Vol 109 (8) ◽

pp. 1646-1653 ◽

Cited By ~ 32

Author(s):

Nita L. Seibel ◽

Mark Krailo ◽

Zhengjia Chen ◽

John Healey ◽

Philip P. Breitfeld ◽

...

Keyword(s):

Children And Adolescents ◽

Poor Prognosis ◽

Metastatic Osteosarcoma

Download Full-text

Size distribution and metastasis in discarded intrapulmonary lymph nodes (LN) after lung cancer resection.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.7072 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 7072-7072

Author(s):

Laura Elizabeth Miller ◽

Robert A. Ramirez ◽

Christopher Gene Wang ◽

Courtney A Adair ◽

Allen Berry ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Metastatic Disease ◽

Lung Resection ◽

Optimal Number ◽

Pathology Report ◽

Test Results ◽

Cancer Resection ◽

T Category

7072^ Background: Lymph node (LN) status is the most important prognostic determinant after resection of lung cancer. 18% of a SEER cohort and 12% of a Memphis cohort had no LNs examined (pNx). Patients with pNx have inferior survival to T-category matched pN0 patients with at least 1 LN examined. The optimal number of LN needed to safely declare a patient pN0 may be >10. Less than 20% of resections in SEER achieve this. We hypothesized that a significant number of intrapulmonary LNs are left unexamined and some may harbor metastatic disease. We report the size characteristics of materials examined in a re-dissection protocol to test this hypothesis. Methods: Prospective study of lung resection specimens re-dissected after signout of the final pathology report. Remnant lung material was dissected with thin cuts and all LN-like material was retrieved for microscopic examination, irrespective of size or location. The size of non-LN tissue, LN without metastasis and LN with metastases were compared using the Wilcoxon-Mann-Whitney test. Results: 112 specimens were examined and 1,094 LN-like materials were retrieved. 749 (69%) proved to be LN tissue. 71 (10%) LNs retrieved had metastasis. Non-LN tissue was significantly smaller than LN tissue (p<0.0001). LNs with metastasis were significantly larger than those without metastasis (p <0.0001). 60% of materials >2cm were LNs with metastasis. 7% of materials <1cm were LN with metastasis. 52% of LNs with metastasis, and 55% of LNs without metastasis measured from 0.5 to 1.5cm (Table). Majority of LNs >2cm had metastatic disease, but 40% did not; a notable proportion of LNs with metastasis were small. Nearly equal percentages of LNs with and without metastasis were found in the range of 0.5-1.5cm. Conclusions: Statistical differences in size between lymph nodes with and without metastasis is clinically meaningless due to broad overlap. LN size alone is not an adequate predictor of LN metastasis. [Table: see text]

Download Full-text

A Randomized Comparison of two Short Intensive Chemotherapy Regimens in Children and Young Adults With Osteosarcoma: Results in Patients With Metastases: A Study of the European Osteosarcoma Intergroup

Sarcoma ◽

10.1080/13577149778245 ◽

1997 ◽

Vol 1 (3-4) ◽

pp. 155-160 ◽

Cited By ~ 10

Author(s):

Vivien H. C. Bramwell ◽

Marion V. Burgers ◽

Robert L. Souhami ◽

Antonie H. M. Taminiau ◽

Jan W. Van Der Eijken ◽

...

Keyword(s):

Drug Treatment ◽

Metastatic Disease ◽

Performance Status ◽

High Dose ◽

Primary Tumors ◽

Metastatic Osteosarcoma ◽

Children And Young Adults ◽

The Difference ◽

Long Term Survivors

Purpose. To report the outcome of 37 patients with metastatic osteosarcoma entered into a large randomized trial (EOI 80831/MRC B002) comparing two different regimens of chemotherapy in patients with osteosarcoma.Methods. Patients with biopsy-proven osteosarcoma localized and metastatic, age 40 years or younger, were randomized to receive either two-drug treatment with doxorubicin/cisplatin (DOX 25 mg m−2day−1× 3 + DDP 100 mg m−2on day 1 q 3 weeks × 6 courses) or three-drug treatment comprising high-dose methotrexate (HDMTX 8 mg m−2administered every412weeks × 4 courses) given 10 days before DOX/DDP.Results. Twenty-four patients with metastatic disease received the two-drug arm treatment and 13 received three-drug treatment. Despite chance imbalance in numbers, there were no major differences in age, sex, primary site or performance status. Baseline alkaline phosphatase (AP) was elevated more frequently (96 vs 42%) in the two-drug arm. Twenty-one of 24 patients in the two-drug arm and 11/13 patients in the three-drug arm had evaluable primary tumors concurrent with metastases. Respective clinical response rates for the two- and three-drug arms were 48% and 40% for primary tumors, and 33% and 55% for metastases. Respective survivals at 2 and 4 years were 36% and 9% for the two-drug arm, and 69% and 52% for the three-drug arm, and survival was better for patients with normal AP at presentation. When adjusted for AP, survival was not significantly different between the two treatments (hazard ratio 0.52, 95% confidence interval 0.22–1.23,p= 0.14). There were three long-term survivors among the metastatic patients, all of whom received the three-drug therapy.Discussion. It is likely that random bias in the population (small numbers, imbalance in size of groups, uneven distribution of AP) accounts for the difference in outcome favoring the three-drug treatment in patients with metastatic disease. More reliance can be placed on the finding that disease-free and overall survival in the adjuvant component of this study (Bramwellet al., J Clin Oncol1992; 10: 1579–91) were better after two-drug treatment.

Download Full-text

Conjunctival Melanoma in Childhood and Adolescence: A Systematic Review

Ocular Oncology and Pathology ◽

10.1159/000497813 ◽

2019 ◽

Vol 5 (6) ◽

pp. 387-395 ◽

Cited By ~ 1

Author(s):

Ben W.R. Balzer ◽

Svetlana Cherepanoff ◽

Anthony M. Joshua ◽

Michael Giblin ◽

Robert Max Conway ◽

...

Keyword(s):

Children And Adolescents ◽

Metastatic Disease ◽

Small Sample Size ◽

Management Strategies ◽

Disease Recurrence ◽

Small Sample ◽

Excision Biopsy ◽

Childhood And Adolescence ◽

Conjunctival Melanoma ◽

History Of

Background: Conjunctival melanoma is rare in adults and rarer in children. We systematically reviewed the presentation, diagnostic and management strategies as well as outcomes for conjunctival melanoma in children and adolescents. Methods: The following databases were searched: Medline, Embase, Web of Science and Scopus for cases of conjunctival melanoma occurring in children and adolescents < 18 years of age. Results: Seventeen studies with 32 patients (18 males) were identified. The median age at presentation was 11 years (range 4–18 years). Most patients were white. Most patients presented with a conjunctival mass or naevus with a recent history of growth or change. Excision biopsy provided diagnosis and management for all cases. Adjuvant chemotherapy and radiotherapy were also used. One patient had metastatic disease at diagnosis and 3 developed metastatic disease (range 1–10 months). Two patients died from disease and one was alive with metastatic disease. Two patients had disease recurrence. Outcomes were observed to be better where diagnosis was made earlier and “no-touch” excision biopsy was performed in an appropriate specialist setting. Conclusions: Conjunctival melanoma occurs rarely in children and adolescents. Surgery is the mainstay of management. The prognosis is guarded in metastatic disease due to the small sample size and limited follow-up.

Download Full-text

Extraskeletal Cartilaginous, Osseous, and Chordoid Tumors in Children and Adolescents

Pediatric and Developmental Pathology ◽

10.2350/10-07-0875-pb.1 ◽

2012 ◽

Vol 15 (1_suppl) ◽

pp. 255-266 ◽

Cited By ~ 1

Author(s):

Justin M. M. Cates ◽

Cheryl M. Coffin

Keyword(s):

Differential Diagnosis ◽

Children And Adolescents ◽

Metabolic Disorders ◽

Myositis Ossificans ◽

Clinicopathologic Features ◽

Metastatic Osteosarcoma

Extraskeletal cartilaginous, osseous, and chordoid tumors are extraordinarily rare in children and adolescents. These lesions are diagnostically challenging due to their rarity and their overlap with metastatic osteosarcoma, reactive or metabolic calcifying and bone-forming masses, various pseudosarcomatous proliferations such as myositis ossificans, and other rare genetic or metabolic disorders. This article reviews the clinicopathologic features and differential diagnosis of extraskeletal cartilaginous, osseous, and chordoid neoplasms in the first two decades of life and highlights the use of diagnostic adjuncts.

Download Full-text

Metastatic osteosarcoma and multiple lung resection. A case report

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.68b5.3465733 ◽

1986 ◽

Vol 68-B (5) ◽

pp. 748-750 ◽

Cited By ~ 1

Author(s):

D Blasier ◽

I Mayba ◽

C Ferguson ◽

D DeSa ◽

A Bishop ◽

...

Keyword(s):

Case Report ◽

Lung Resection ◽

Metastatic Osteosarcoma

Download Full-text

Metastatic Patterns in Osteosarcoma

Tumori Journal ◽

10.1177/030089168807400408 ◽

1988 ◽

Vol 74 (4) ◽

pp. 421-427 ◽

Cited By ~ 41

Author(s):

Gaetano Bacci ◽

Maddalena Avella ◽

Piero Picci ◽

Antonio Briccoli ◽

Dante Dallari ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Metastatic Disease ◽

Pulmonary Metastases ◽

Primary Lesion ◽

Metastatic Osteosarcoma ◽

Number Of Patients ◽

History Of ◽

Metastatic Patterns ◽

First Relapse ◽

Rizzoli Orthopaedic Institute

The clinical courses of 193 patients with high-grade, non-metastatic osteosarcoma were reviewed to ascertain the evolution of the natural history of the disease. All patients had the primary lesion in the extremities and were treated at the Rizzoli Orthopaedic Institute between 1976 and 1982 with surgery alone (30 cases) or surgery plus adjuvant chemotherapy (163 cases). All patients were regularly followed at our Institute. One hundred and fourteen patients, of which 27 were treated with surgery alone and 87 treated with adjuvant chemotherapy, developed overt metastatic disease. No differences were found concerning the sites of the first relapse which, for approximately 90 % of cases, were lungs in both groups. However, in the group of patients treated with adjuvant chemotherapy the development of overt metastatic disease, as compared to non-adjuvant patients, was delayed with time (13 vs 8 months) and the number of metastatic nodules in the lung at first relapse was reduced. This alteration in metastatic pattern due to adjuvant chemotherapy is important because it allows surgical resection of pulmonary metastases in a larger number of patients (51 % vs 29 %).

Download Full-text