Chest
Volume 116, Issue 6, December 1999, Pages 1811-1814
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Selected Reports
Endobronchial Metastasis From Osteosarcoma of Bone: Treatment With Intraluminal Radiotherapy

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Lung parenchymal metastases are common manifestations in patients with osteosarcoma; however, spread to the major airway itself is extremely rare. We present a young man who had been previously treated with surgical resection following preoperative chemotherapy and immediate postsurgical adjuvant chemotherapy for proximal tibial osteosarcoma. He developed metastasis to the major airways. The patient was treated with intraluminal radiotherapy (ILT) for the endobronchial metastasis. This is the first report of an endobronchial osteosarcoma that was treated with ILT with a complete endoscopic response. ILT provided excellent palliation in this particular case.

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Case Report

A 21-year-old man presented with a 2-month history of gradually increasing dyspnea, nonproductive cough, and wheeze. He gave a history of weight loss of about 15 kg over a year. He also reported 2 days of fever.

Approximately 3 years (34 months) before his current problems occurred, the patient had pain and swelling in the left knee, which on excision biopsy had been proved to be caused by an osteosarcoma of the bone. At that time, CT scans of the cranium, thorax, and abdomen, along with bone

Discussion

We present a young man with osteosarcoma of the proximal tibia who developed extensive metastatic disease involving the lung parenchyma and, more interestingly, the major airways, and in whom ILT provided effective palliation.

It has been suggested that osteosarcoma should be regarded as a metastatic disease, even when only a single primary lesion is found at the initial presentation.6 Metastatic disease to the lungs is found in the majority of patients dying of osteosarcoma. However, spread to

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Currently at North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK.

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