Abstract
The paper presents a detailed comparison of the anatomical distribution and frequency of clinically evident metastases in 152 cases of osteosarcoma, and autopsy findings in 43 cases. The behaviour of long bone tumours is contrasted with those arising elsewhere, which tend to metastasize less widely because of early death from effects of the primary tumour. In both clinical and autopsy series long bone tumours produced lung metastases (LM) in over 90% of patients dying with metastases, but the terminal frequency of extra-pulmonary metastases (EPM) rises from a clinical level of 33% to 83% at autopsy. There was little difference between tumours of the major long bones in the frequency of either LM or EPM, but EPM from the humerus tended to be fewer and sited above the diaphragm and from the femur below it. EPM most often involved other bones, notably vertebrae and pelvis. Not more than 10% of tumours invaded regional lymph nodes but terminally a quarter of the long bone tumours had metastasized to heart and abdomen. The infrequency of metastases in muscle was confirmed. The median time for LM was 5-6 months after starting treatment, for EPM 9-10. months. First metastases after 24 months were infrequent, especially in children. With delay in the appearance of metastases, whether LM or EPM, post-metastatic survival lengthened. Neither age, sex nor mode of treatment of the primary notably affected metastatic frequency, although recurrences were much more numerous when radiotherapy, even with high dosage, was the definitive treatment. Local recurrence usually appeared within 6-8 months and was shown to lead to increased frequency of osseous metastases. It is suggested that terminal dissemination may often be tertiary but not always from a pulmonary secondary.
Highlights
There was little difference between tumours of the major long bones in the frequency of either lung metastases (LM) or extra-pulmonary metastases (EPM), but EPM from the humerus tended to be fewer and sited above the diaphragm and from the femur below it
We present an anain young people, lung secondaries are lytical study of the metastatic patterns almost invariably the cause of death, of osteosarcoma arising in otherwise even though metastases in other sites normal bones, as found both clinically
The site of the primary tumour does not materially affect the frequency of metastases but the frequency of clinical EPM is greatest for the femur, with a tendency to more widespread dissemination and involvement of other bones, pelvis and spine, which is apparent in the autopsy records
Summary
FiG. 1 -Metastases to bone and soft tissue from osteosarcoma-all cases, and at autopsy. In the other 9 cases-6 osteosarcomata of long bones and 3 of other bones-the clinical evidence of metastases may be compared with the autopsy findings (Fig. 3). There was rarely sufficient clinical information for comparison with the autopsy records in individual cases and so comparison has had to be made of the overall incidence of metastases with any given site on clinical and autopsy evidence. That this has some validity may be deduced from the very similar figures obtained in the 2 series for pulmonary metastases from the long bone tumours, and for death due to effects of the primary tumour in other sites. It cannot be assumed that they are entirely comparable since some autopsies may have been carried out on account of unusual clinical findings or unexpected death, which might be referable to metastases in obscure sites
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