Resection of pulmonary metastatic osteogenic sarcoma in children.

Over a three year period, 28 children or young adults up to 20 years of age underwent 60 thoracotomies for pulmonary metastatic osteogenic sarcoma. These patients also received adjuvant chemotherapy. Sixteen of the 28 patients are currently alive and 13 of these are free of disease. The patients have been followed for 6 to 48 months after the initial thoracotomy; median survival is 25 months. Actuarial survival curves produced a 4 year survival of 57%. Although a tumor-free interval of more than 1 year greatly enhanced survival, three patients survived with tumor-free interval of 6 months or less. Patients with disease confined to one lobe at the initial thoracotomy did very well, and yet survivors were seen when disease involved more than one lobe or was bilateral. An aggressive surgical approach toward the pulmonary metastases thus appears to be justified.