ABSTRACT
BACKGROUND: Approximately one-third of patients with localized osteosarcoma at presentation relapse as well as about three-fourths of the patients with metastases at diagnosis, about 90% of relapses are lung metastases. The role of lung metastasectomy remains to be determined. PATIENTS: and methods: Three hundred and twenty three patients, 88 with resectable lung metastases at diagnosis and 235 with localized disease at presentation who relapsed with lung metastases were treated. RESULTS: A total of 498 lung surgeries and 607 thoracotomies were performed. The 5 year overall survival was 37%. Final outcome was significantly related to presence or absence of metastasis, time of first relapse and presence of local recurrences. According to stage of the disease, the rate of a 5 year event-free survival (EFS) was 36% for patients with localized disease who later relapsed and 9% for patients with resectable lung metastases at presentation (p<0.0001). However, there were no differences in EFS between patients who underwent two or three thoracotomies and patients who had four or five thoracotomies (7.5 vs 18.7%, p=0.29). CONCLUSIONS: In patients with recurrent resectable pulmonary metastases from high grade osteosarcoma treated with adjuvant or neoadjuvant chemotherapy, thoracotomy should always be considered regardless the number of previous lung relapses and the number of secondary pulmonary lesions.
Subject(s)
Bone Neoplasms/pathology , Extremities , Lung Neoplasms/secondary , Osteosarcoma/secondary , Adolescent , Adult , Bone Neoplasms/drug therapy , Bone Neoplasms/surgery , Child , Child, Preschool , Combined Modality Therapy/methods , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/surgery , Male , Middle Aged , Neoplasm Recurrence, Local , Osteosarcoma/drug therapy , Osteosarcoma/surgery , Retrospective Studies , Survival Analysis , Thoracotomy , Treatment Outcome , Young AdultABSTRACT
It is well know that a long period of ischemia followed by reperfusion can create an irreversible tissue damage, also due to the excessive generation of oxygen-derived free radicals. A possibility for avoiding this syndrome is represented by the use of free radical scavengers, such as the superoxide dismutase (SOD). The current authors compared the results achieved through different modifications of this enzyme in an experimental rat hind limb model of ischemia/reperfusion. 60 rats that had a 4 hour and 30 minute ischemia of the left hind limb were divided into four groups of 15 each and treated using a physiological solution (control group), native SOD, monomethoxypolyethylene-glycol-SOD (mPEG-SOD) or poly(acryloilmorpholine)-SOD (PAcM-SOD). The outcomes obtained in terms of limb survival (p < 0.05), as well as histomorphologic studies (p < 0.0005), revealed a superior capacity of mPEG-SOD when compared with the other three substances.
