Surgery>>>>>Chest Wall, Pleura, and Mediastinum
Question 24#

Osteosarcoma of the rib:

A. Is considered non-operable if pulmonary metastases are present
B. Is treated with radiation therapy before resection
C. Is treated with adjuvant chemotherapy before resection
D. Requires excision with a 6-cm margin

Correct Answer is C

Comment:

While osteosarcomas are the most common bone malignancy, they represent only 10 to 15% of all malignant chest wall tumors. They primarily occur in young adults as rapidly enlarging, painful masses; however, osteosarcomas can occur in older patients as well, sometimes in association with previous radiation, Paget disease, or chemotherapy. Radiographically, the typical appearance consists of spicules of new periosteal bone formation producing a sunburst appearance. Osteosarcomas have a propensity to spread to the lungs, and up to one-third of patients present with metastatic disease. Osteosarcomas are potentially sensitive to chemotherapy. Currently, preoperative chemotherapy is common. After chemotherapy, complete resection is performed with wide ( 4-cm) margins, followed by reconstruction. In patients presenting with lung metastases that are potentially amenable to surgical resection, induction chemotherapy may be given, followed by surgical resection of the primary tumor and of the pulmonary metastases. Following surgical treatment of known disease, additional maintenance chemotherapy is usually recommended.