Rothermundt Christian, Seddon Beatrice M, Dileo Palma, Strauss Sandra J, Coleman Joanne, Briggs Timothy W, Haile Sarah R, Whelan Jeremy S
Division of Oncology/Haematology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
London Sarcoma Service, University College London Hospitals, London, NW1 2BU, UK.
BMC Cancer. 2016 May 6;16:301. doi: 10.1186/s12885-016-2333-y.
The optimal conduct of follow-up (FU) of patients with osteosarcoma is uncertain. In the absence of any formal validation of optimal timing and method of surveillance, guidance is provided by oncology societies' recommendations. FU is designed to detect either local recurrence or metastatic disease at a time when early treatment is still possible and might be effective.
We performed a retrospective analysis of 101 patients with high-grade extremity osteosarcoma in a single centre. Chest x-ray (CXR) was used as routine surveillance method; however patients with initial lung metastases or previous suspicious findings had computed tomography (CT) scans.
With a median FU time of 30.7 months 34 patients relapsed. Relapse-free survival after 5 years was 61% (CI 52%; 73%), late relapses occurred in only two patients between 2 and 5 years of FU. Twenty-five of the 34 relapses were detected at routine FU appointments. All 8 local recurrences were noted clinically. Twenty-two patients had metastases confined to the lungs, either detected on CXR or CT. Thirty-two percent of patients with lung metastases only were salvaged successfully.
Routine FU in high-grade osteosarcoma results in clinical detection of local relapse, and detection of lung metastases by CXR at a time when metastatectomy is possible. The optimal time interval for FU appointments is not known, however we recommend more frequent surveillance visits during the two years after treatment. We hypothesize that routine CT scans are not required and propose CXR for detection of lung metastases.
骨肉瘤患者随访的最佳方式尚无定论。在缺乏对最佳监测时间和方法进行任何正式验证的情况下，肿瘤学协会的建议提供了指导。随访旨在在仍有可能进行早期治疗且可能有效的时候检测局部复发或转移性疾病。
我们对单中心的101例高级别肢体骨肉瘤患者进行了回顾性分析。胸部X光（CXR）用作常规监测方法；然而，初始有肺转移或先前有可疑发现的患者进行了计算机断层扫描（CT）。
中位随访时间为30.7个月，34例患者复发。5年后无复发生存率为61%（95%CI 52%；73%），仅2例患者在随访2至5年之间出现晚期复发。34例复发中有25例在常规随访预约时被检测到。所有8例局部复发均通过临床发现。22例患者的转移局限于肺部，通过CXR或CT检测到。仅肺转移患者中有32%成功挽救。
高级别骨肉瘤的常规随访可临床检测到局部复发，并在可进行转移灶切除时通过CXR检测到肺转移。随访预约的最佳时间间隔尚不清楚，然而我们建议在治疗后的两年内进行更频繁的监测。我们推测不需要常规CT扫描，并建议用CXR检测肺转移。
