Treatment of osteogenic sarcoma. II. Aggressive resection of pulmonary metastases.

Thirty-nine patients with osteogenic sarcoma were treated in a prospective protocol involving the use of adjuvant high-dose methotrexate, frequent screening for pulmonary metastases, and aggressive resection of all metastatic disease whenever possible. Twenty-two of these 39 patients have had recurrence and in 20 patients evidence of metastatic disease was confined to the lungs. Eighteen of the patients had thoracotomy, and in 11 patients all known disease was resected. Although four of these patients have required further thoracotomies, all 11 patients have no evidence of disease. Thus, of the original 39 patients, 30 (76.9%) are now alive and 28 (71.8%) have no evidence of disease, with a median followup of 27 months. Survival is significantly improved compared to historical control patients (P less than 0.001; one-sided Kruskal-Wallis test).