Primary Pulmonary Metastatic Osteosarcoma: To Stop or Not to Stop, That is the Question

An 18-year-old presented with a large, high-grade osteosarcoma of the proximal femur and multiple primary pulmonary metastases. The tumor responded poorly to preoperative chemotherapy. Four thoracotomies to remove 24 metastases were necessary to achieve a first complete remission. An early pulmonary recurrence was again treated by thoracotomy and systemic therapy. The patient remained in second complete remission at the last follow-up, 76 months after post-diagnosis and 53 months after pulmonary recurrence. This case illustrates that some patients with osteosarcoma and extremely doubtful prognosis may be cured, provided the treatment concept includes aggressive surgery for both the primary tumor and metastatic disease.