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Osteosarcoma follow-up: chest X-ray or computed tomography?

Anna Paioli1, Michele Rocca2, Luca Cevolani3

  • 1Chemotherapy Unit, Istituto Ortopedico Rizzoli, via Pupilli, 1, 40136 Bologna, Italy.

Clinical Sarcoma Research
|February 24, 2017
PubMed
Summary

Computed tomography (CT) surveillance for osteosarcoma lung metastases significantly improves the rate of second complete remission (CR-2) and survival outcomes compared to chest X-ray. This imaging approach enhances post-relapse survival (PRS) and overall survival (OS) in recurrent osteosarcoma patients.

Keywords:
Chest X-rayChest computed tomographyFollow-upOsteosarcoma

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Area of Science:

  • Oncology
  • Medical Imaging
  • Osteosarcoma Research

Background:

  • Relapsed osteosarcoma necessitates effective surveillance for metastatic disease.
  • Surgical resection achieving second complete remission (CR-2) is crucial for post-relapse survival (PRS).
  • Current osteosarcoma follow-up lacks a validated chest surveillance policy, with both chest X-ray and computed tomography (CT) being used.

Purpose of the Study:

  • To evaluate the impact of chest surveillance modality (X-ray vs. CT) on CR-2 rates.
  • To determine if imaging technique influences prognosis in recurrent osteosarcoma.
  • To compare post-relapse survival (PRS) and overall survival (OS) based on surveillance method.

Main Methods:

  • Analysis of extremity osteosarcoma patients (up to 40 years) treated between 1986-2009.
  • Inclusion criteria: lung metastases as the sole recurrence pattern.
  • Endpoints assessed: CR-2 rate, PRS, and OS.

Main Results:

  • CT detected lung metastases in 52% of patients, compared to 47% with X-ray.
  • CR-2 rates were significantly higher with CT (88%) versus X-ray (60%).
  • 5-year PRS was 49% for CT vs. 30% for X-ray; 5-year OS was 60% for CT vs. 35% for X-ray.

Conclusions:

  • Chest CT surveillance is superior to chest X-ray for detecting lung metastases in osteosarcoma.
  • A CT-based follow-up strategy significantly increases CR-2 rates.
  • CT surveillance demonstrably improves PRS and OS in patients with recurrent osteosarcoma.