Abstract 4045: Pediatric osteosarcoma lung metastasis: variations in clinical management

Abstract

Abstract Background: Nearly 20% of patients with newly diagnosed osteosarcoma have detectable metastatic disease at presentation, most of which is located in the lungs. These patients have a poor prognosis with survival of generally less than 30%. NCCN guidelines as well as many osteosarcoma clinical trials endorse resection of metastases as part of standard treatment. There are limited recommendations as to the timing or method of resection. Methods: An anonymous online questionnaire was distributed to establish practice patterns among members of the Connective Tissue Oncology Society, a multi-disciplinary sarcoma focused organization. Participants were asked about management of lung metastases in 3 clinical scenarios (2 cm unilateral, 0.5 cm unilateral, and multiple bilateral lung nodules). Questions evaluated timing of management, decision to resect, technique of resection, and decision to explore the contralateral lung. Results: 183 individuals completed the survey. Most report initiating nodule management after neoadjuvant therapy. If the nodule disappeared after neoadjuvant therapy or definitive surgery, most report not performing surgical resection. Among nodules resected after neodjuvant therapy or definitive surgery that were unchanged in size, thoracotomy is the most commonly reported surgical technique. When only unilateral nodules were present on imaging, few choose to explore the contralateral lung (11% in 2.0cm and 10% in 0.5cm, compared to 70% in multiple bilateral nodules). Pediatric Oncologists were more likely to initiate management earlier than Medical Oncologists for 2.0cm nodule (90% vs 63%, p<0.001), 0.5 cm nodule (77% vs. 47%, p <0.005), and multiple bilateral nodules (79% vs. 51%, p =0.008). Conclusion: There is marked heterogeneity among treating clinicians in their management of pulmonary metastases in osteosarcoma. Variation was also noted between medical specialties. Prospective trials are needed to evaluate if these differences have significant implications on outcomes for patients with newly diagnosed metastatic osteosarcoma. Citation Format: Andrea T. Vo, Onita Bhattasali, Michael Roth, Jonathan Gill, David Geller, Lor Randall, Richard Gorlick. Pediatric osteosarcoma lung metastasis: variations in clinical management. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4045. doi:10.1158/1538-7445.AM2014-4045