Abstract
BACKGROUND AND OBJECTIVE: Osteosarcoma is the most frequent primary cancer of bone. The incidence is higher in adolescents. Large improvement, though, has been made in the treatment of osteosarcoma under the framework of multidisciplinary team, an important prognostic factor for osteosarcoma is pulmonary metastasis. Surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. Undoubtedly, surgical resection of lung metastases is widely accepted as the optimal modality in osteosarcoma patients. However, since current conceptions within the surgical approach to lung metastasectomy involve multidisciplinary collaboration, which are highly variable,there is not neither consensus nor standardized practice patterns. We conduct a survey aiming to reveal areas of consistency in current clinical practice on lung metastasectomy among Chinese osteosarcoma high volume centers. METHODS: A questionnaire survey specific to the nationwide high volume centers of osteosarcoma was conducted from September 2015 to November 2015. Analyses were stratified by hospital, working duration, case volume and medical discipline. RESULTS: Of 150 invited physicians, 105 participated, resulting in an overall response rate of 70%. Forty-one percent of the responded physicians agreed with the statement that orthopedic oncology should play a predominant role in the multidisciplinary team. More than 64% of respondents chose metastasectomy as the preferred local control approach, and up to 78.1% of respondents recommended pulmonary metastasectomy for patients. Compared with orthopedic surgeons, other physicians were significantly more likely to report not advocating pulmonary metastasectomy in their practice (OR(others)=0.02; 95%CI: 0.00-0.22; P=0.001), and thoracic surgeons were more likely to decide metastasectomy according to indications rather than the number limit of metastases (OR(thoracic surgeons)=20.93; 95%CI: 2.05-213.64; P=0.001). For the most preferred radiographic evaluation option, approximately 83% of respondents reported diagnostic use of computed tomography (CT). More than 70% of respondents reported that chest CT follow-up should be 3 months after the primary site resection; approximately 68% deemed the diagnostic accuracy of CT about 90%; most respondents (92%) recommended the extrapulmonary imaging evaluation simultaneously. Around 46% of respondents reported that survival duration longer than 6 months after pulmonary metastasectomy is beneficial. CONCLUSION: This study offers new information about the variability in the reported management of pulmonary metastatic osteosarcoma in China, reflecting the deficiencies in unified practice patterns. The results of this survey also provide baseline data for future research and for the development of international guidelines.