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KMID : 0613319960020020149
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Journal of the Korean Bone and Joint Tumor Soceity
1996 Volume.2 No. 2 p.149 ~ p.154
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A Study of Pulmonary Metastasis in Osteosarcoma
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Kim Jae-Do
Kang Nam-Wook
Hong Young-Gi
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Abstract
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Neoadjuvant vhemotherapy has dramatically reduced the metastatic death rate in osteosarcoma, but 30% to 40% of patient still die of pulmonary metastasis. This study investigated the prognostic factors of pulmonary metastasisin osteosarcoma and evaluated thd effect of neoadjuvant chemotherapy in preventing pulmonary metastasis and survival rate. From January 1987 to June 1996, we reviewed 55 patients with osteosarcoma. The mean duration of follow up was 30 months(ranging from 8 months to 69 months). The patients were classified as three following groups : 1) primary amputation without chemotherapy(7cases), 2) low-dose adjuvant chemotherapy following operation(17 cases), 3) neoadjuvant chemotherapy following operation(35 cases). The survival rate, incidence of pulmonary metastasis and duration of survival after pulmonary metastasis were compared among three groups. The duration of symptom, LDH level, and tumor size
were compared between pulmonary metastasis group and non-pulmonary metastasis group. Statistic comparison of the results was done with Kaplan-Meier`s method, generalised Wilcoxon`s Test, Logrank Test and chi-squre test. The pulmonary netastasis developed in 21 patient(39.3%). The 2-year and 4-year survival rate of pulmonary metastasis group was 15% and 0% respectively. The incidence of pulmonary metastasis in group 1), 2), 3) were 37%, 76% and 16% respectively. Group 3 showed significantly lower incidence of metastasis (p<0.001) than those of the other two groups. Mean interval of the development of pulmonary metastasis is 7.4 months(ranging from 0 month to 30 months). According to groups, mean interval of development of pulmonary metastasis is 7.54 months in group 1), 6.9 months in group 2), and 7.9 months in group 3), which was no significant difference statistically. The patients with pulmonary metastasis showed relatively short duration of symptom(more than 2 months : 24.1%, less than 2month : 55.56%, p=0.01) and large tumor size(metastasis group : 13.5 cm, non-metastasis group: 9.8cm, p=0.04). The intensive neoadjuvant chemotherapy combined with the adequate wide excision of the tumor and metastatectomy is the most important to prevent the pulmonary metastasis and prolong the survival rate.
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KEYWORD
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Osteosarcoma, Pulmonary Metastasis, Neoadjuvant Chemotherapy
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