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Pulmonary metastases in childhood sarcoma
Insights
Aggressive pulmonary resection offers survival benefits for pediatric patients with controlled sarcomas and limited metastatic disease. Surgical approaches like median sternotomy may be beneficial for certain tumor types.
Area of Science:
- Pediatric Oncology
- Thoracic Surgery
- Surgical Oncology
Background:
- Pulmonary metastases are a significant challenge in pediatric sarcoma patients.
- Surgical resection of lung metastases is a potential treatment modality.
Purpose of the Study:
- To evaluate the efficacy of aggressive pulmonary resection in pediatric patients with metastatic sarcomas.
- To identify patient subgroups that may benefit most from surgical intervention.
Main Methods:
- Retrospective analysis of 56 patients under 19 years old with pulmonary metastases from various sarcomas.
- Review of surgical interventions, including thoracotomies and pulmonary resections.
- Survival data analysis based on primary tumor type and surgical approach.
Main Results:
- Overall survival was 20% for osteogenic sarcoma, 25% for Wilms' tumor, and 50% for Ewing's sarcoma and other soft tissue malignancies.
- 18 patients with osteogenic sarcoma underwent 37 thoracotomies; 5 patients with Wilms' tumor underwent 7 thoracotomies.
- Pulmonary resection showed a role in improving survival when the primary tumor was controlled and no other metastatic disease was present.
Conclusions:
- Aggressive pulmonary resection is indicated for pediatric patients with controlled primary sarcomas and isolated pulmonary metastases.
- Median sternotomy may be a suitable surgical approach for osteogenic sarcoma and Wilms' tumor due to bilaterality and multicentric implants.
Abstract:
A retrospective analysis of 56 patients less than 19 years old with pulmonary metastases from previously diagnosed sarcomas was performed. Thirty patients had primary osteogenic sarcoma. Eighteen of them underwent a total of 37 thoracotomies. Overall survival was 20%. Twelve patients were noted to have metastatic Wilms' tumor, and 5 of them underwent 7 thoracotomies. This group had a 25% overall survival. Six patients had pulmonary metastases from Ewing's sarcoma. Four of these required pulmonary resection. The overall survival in these patients was 50%. The remaining 8 patients had pulmonary resection for various soft tissue malignancies, with an overll survival of 50%. The results of this review indicate a role for aggressive pulmonary resection in patients in whom the primary tumor is controlled and there is no other evidence of metastatic disease. The frequency of bilaterality and multicentric implants in patients with osteogenic sarcoma and Wilms' tumor suggest the efficacy of a median sternotomy approach in these patients.