Non-Surgical Treatment of Pulmonary and Extra-pulmonary Metastases

Part of the Cancer Treatment and Research book series (CTAR, volume 152)


Studies have demonstrated that chemotherapy alone is usually unsuccessful as exclusive therapy for osteosarcoma (Cancer 95:2202–2201, 2002). Information will be presented for situations where non-surgical alternatives could be considered as useful, if not necessary, adjuncts to chemotherapy. In the thorax these include treatment of pleural effusions, chest wall lesions, central lung or mediastinal osteosarcoma, as well as recurrences in patients with limited pulmonary reserve. Other situations include too many metastases to easily resect, axial osteosarcomas, bone metastases, liver and brain metastases.

Non-surgical local control measures include radiation with chemotherapy for radiosensitization, bone-seeking radioisotopes (e.g., 153Sm-EDTMP, 223Ra), bisphosphonates, heat (radiofrequency ablation), freezing and thawing (cryoablation), and intracavitary or regional (aerosol) therapy. Because of the predictable and common pattern of pulmonary metastases in osteosarcoma, aerosol therapy also offers an attractive regional treatment strategy. Principles and use of aerosol cytokines (e.g., GM-CSF, IL-2), and aerosol chemotherapy with gemcitabin will be discussed. Individual cases illustrating strategy and techniques will be presented.


Local Control Thermal Ablation Doxorubicin Liposome Metastatic Osteosarcoma Central Lung 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author thanks the many members of the MD Anderson Cancer Center that make multidisciplinary care for metastases possible including Dr. Kamran Ahrar (interventional radiology), Dr. Andrea Hayes-Jordan (Pediatric Surgery), Dr. Ara Vaporciyan (thoracic Surgery), Dr. Rudolfo Nunez (Nuclear Medicine), Dr. Nancy Fitzgerald (Pediatric Radiology), Maritza Salazar-Abshire, RN, Margaret Pearson , CNP, and Kathy Cornelius.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Children’s Cancer Hospital, University of Texas MD Anderson Cancer Center, Unit 87, PediatricsHoustonUSA

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