Osteosarcoma lung metastases detection and principles of multimodal therapy.

The management of pulmonary metastases poses a challenge to the multidisciplinary team involved in the treatment of osteosarcoma. A postal survey on the management of pulmonary metastases in osteosarcoma involving 17 representatives from international study groups and selected institutions was performed in which a response rate of 94% was achieved. The results showed uniform approaches in areas like the imaging methods used for initial staging and the use of manual exploration with thoracotomy. However, it demonstrated diverse practices regarding exploration of the unaffected site in unilateral pulmonary disease, and the approach to lesions disappearing under chemotherapy. Furthermore, agreement on the size of a lesion considered to distinguish between benign and of metastatic origin, varied. Based on the survey and a review of the current literature, detection methods and principles of multimodal therapy will be discussed. Prognostic factors in synchronous and metachronous pulmonary metastases and their implications for a multimodal therapy is also presented.