The lungs are the most common location for osteosarcoma to metastasize. Similar to primary tumor location the treatment is usually a combination of chemotherapy and surgery to remove the tumor(s). Understanding treatment options of osteosarcoma and lungs can be confusing, so it’s important to understand what metastasizing means for your treatment plans.
There are a couple different types of surgical procedures used to remove osteosarcoma from the lungs. Your treatment team should provide you with the information to determine what route is best for treating osteosarcoma that has spread to the lungs.
A thoracotomy is an invasive surgical procedure that allows the surgeon to deflate the lung(s) and manually palpate the lung tissue with her/ his fingers to find nodules in the thoracic cavity. While it is more invasive, it is often seen as the preferable surgery as a surgeon can find and remove more nodules than are visually seen on a CT scan or through a thoracoscopy. Removing more nodules has the potential to decrease additional disease being found after surgery.
Thoracoscopy/pleuroscopy is a minimally invasive procedure that allows access to the lungs or pleural space using a combination of viewing and working instruments (clamps, scalpels, etc.). It allows for internal examination, biopsy, and/or resection of disease or masses within the pleural cavity and thoracic (lung) cavity. Thoracoscopy may be performed either under general anesthesia or under sedation with local anesthetic.
Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient’s chest via small incisions. The surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating.
Tumors can be tested for genetic changes that may inform care. All tumor tissue goes to the pathology department. As discussed earlier in this chapter; current standard pathology protocols often decalcify the tumor tissue with strong acid. Unfortunately, once a tumor has been decalcified, it cannot be genetically tested as the DNA has been damaged by the acid in the decalcification process. Therefore, changing these protocols may be best to save some tumor in its natural (calcified state) in the freezer, or processed with gentle decalcification techniques, which allows for genetic testing at this point or a future date if relapse occurs. Preserving tissue with intact DNA and RNA is also an important avenue for researchers to learn more about osteosarcoma to help future patients. The goal of testing tumor tissue is to identify genetic changes that are present only in the tumor cells and is different from testing for familial, or germline, gene changes that run-in families. Genetic testing can take significant time- four to eight weeks, so determining the best time to pursue genetic testing should include this information.
Recovery time from any osteosarcoma surgery is significant. Generally, surgeons will have to determine when enough recovery has taken place to restart chemotherapy. Chemotherapy for osteosarcoma in the lungs is a life-saving treatment, yet can slow down recovery from surgery. It is a delicate balance determining how long to heal from surgery without allowing new disease to grow before resuming chemo. Management of pain, beginning movement and physical therapy can all be very draining and time-consuming. Remember that focus during this time should be on recovery and healing; socialization, school, and activities, while important, should be seen as second to rest and recovery. Listen to your doctor- this is a very unique surgery; it is not similar to a knee or shoulder replacement. Your child’s needs for mobility and physical therapy will be significant. Being sure to gain mobility and weight bearing at appropriate times to maximize mobility while minimizing potential injury is crucial. Be a resource to your loved ones, and find ways to cope with stress in a healthy way.