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• W2589204174 abstract "10036 Background: Extrapulmonary osteosarcoma (OS) metastases portend poor outcome and short survival. Local control is essential for durable remission. Intracardiac, mediastinal and CNS metastases are ominous: many oncologists cease therapy when they occur. We present a series of 19 patients with relapse in poor-prognosis locations, and focus on one patient in 3rd relapse of OS in whom widespread disease, including intraventricular and CNS metastases, was controlled with chemotherapy, radiotherapy, novel agents, cardiac tumor resection and neurosurgery. Methods: Imaging included CT, PET-CT, bone scan, echocardiogram, and MRI. Systemic therapy included liposomal doxorubicin (D), bevacizumab (A), rapamycin (R), cisplatin (C), valproic acid (V), and zoledronic acid (ZA). Other patients received ifosfamide, samarium with gemcitabine, cyclophosphamide, temezolomide, and L-MTP-PE. Local control included surgery for cardiac and mediastinal metastasis and XRT or surgery for CNS metastasis. Results: D+A caused tumor shrinkage. The patient received XRT to 9 sites over 4 courses with C (q 2 wk), R (daily), V (daily) or ZA (q 4 wk) for radiosensitization. PET-CT after 8 weeks showed metabolic resolution of most lesions, regardless of XRT. Echocardiogram identified 2 LV cardiac metastases, which were resected without complication. A left parietal mass was resected with no complication and normal neurologic exam post-surgery. The patient is doing well on treatment 11 months after relapse, with few sites of active disease and good quality of life. The majority of patients had reduced tumor burden and objective responses on PET-CT. Good post-operative quality of life was achieved after resection of cardiac (1), mediastinal (5) or CNS (2) metastases. XRT with chemotherapy was used for 6 mediastinal and 5 skull/CNS patients. 2/12 mediastinal and 0/7 CNS patients had developed recurrent disease in these sites. Conclusions: Novel agents were well-tolerated and effective, enabling aggressive local control in difficult-to- treat locations. PET-CT gave an earlier and more accurate measure of response than CT alone. Resection of cardiac, mediastinal and CNS metastases in pediatric patients is feasible and can be well-tolerated, prolonging survival and improving quality of life. No significant financial relationships to disclose." @default.
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• W2589204174 date "2008-05-20" @default.
• W2589204174 modified "2023-10-18" @default.
• W2589204174 title "Intracardiac, mediastinal and CNS metastases in pediatric osteosarcoma: extending survival" @default.
• W2589204174 doi "https://doi.org/10.1200/jco.2008.26.15_suppl.10036" @default.
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