An 18-year-old treated for osteosarcoma of the tibia develops two small, completely resectable peripheral nodules in the right upper lobe of the lung. There is no other site of disease. The most appropriate management is:

• A Palliative chemotherapy alone with no thoracic intervention
• B Whole lung irradiation as the sole modality
• C Surgical resection of the pulmonary metastases combined with further chemotherapy ✓
• D Observation with serial CT scans, intervening only if the nodules enlarge

Explanation

In osteosarcoma, complete surgical resection of pulmonary metastases offers the only real chance of cure after relapse, and outcomes depend chiefly on whether all nodules are resectable and their number. Two resectable peripheral nodules warrant metastasectomy together with continuation of chemotherapy. Observation forfeits curative intent, whole lung irradiation alone is inferior, and palliative chemotherapy abandons a potentially operable situation. Five-year survival after complete resection of limited metastases approaches 30 to 40 percent.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.