Thoracotomy Versus Thoracoscopic Management of Pulmonary Metastases in Patients with Osteosarcoma
This phase III trial compares the effect of open thoracic surgery (thoracotomy) to thoracoscopic surgery (video-assisted thoracoscopic surgery or VATS) in treating patients with osteosarcoma that has spread to the lung (pulmonary metastases). Open thoracic surgery is a type of surgery done through a single larger incision (like a large cut) that goes between the ribs, opens up the chest, and removes the cancer. Thoracoscopy is a type of chest surgery where the doctor makes several small incisions and uses a small camera to help with removing the cancer. This trial is being done evaluate the two different surgery methods for patients with osteosarcoma that has spread to the lung to find out which is better.
Eligibility
Inclusion Criterea
- Patients must be < 50 years at the time of enrollment.
- Patients must have == 3 mm and all of which must be =< 3 cm size.
* Note: Patient must have eligibility confirmed by rapid central imaging review.
- Lung nodules must be considered resectable by either open thoracotomy or thoracoscopic surgery. Determination of resectability is made by the institutional surgeon.
- Patients must have a histological diagnosis of osteosarcoma.
- Patients must have evidence of metastatic lung disease at the time of initial diagnosis, or at time of 1st recurrence following completion of therapy for initially localized disease.
- Patients with newly diagnosed disease must have completed successful gross tumor resection for their primary tumor or surgical local control of primary tumor must be planned to be performed simultaneously with thoracic surgery.
- Newly diagnosed patients must be receiving or recently completed (within 60 days) systemic therapy considered by the treating physician to be standard treatment for newly diagnosed osteosarcoma (eg, cisplatin-doxorubicin or ifosfamide-based drug regimens) at the time of enrollment on this study. Dose and drug modifications for toxicity do not exclude patients from participation.
- Patients at time of 1st recurrence must have completed systemic therapy for their initial primary tumor, considered by the treating physician to be standard treatment for newly diagnosed osteosarcoma (eg, cisplatin-doxorubicin or ifosfamide-based drug regimens) at the time of enrollment on this study. Dose and drug modifications for toxicity do not exclude patients from participation.
- Patients with unresectable primary tumor.
- Patients with pulmonary metastatic lesions that would require anatomic resection (lobectomy or pneumonectomy) or lesions that are defined as “central” (i.e., central lesion involves or is proximal to segmental bronchi and peripheral is lesion distal to segmental bronchi).
- Patients with chest wall or mediastinal based metastatic lesions, or with significant pleural effusion.
- Patients with disease progression at either the primary or pulmonary metastatic site while on initial therapy. Note: Once the patient has been enrolled on the study, additional computed tomography (CT) scans are not anticipated prior to thoracic surgery. Note: Some variation in nodule size measurements over the course of pre-operative therapy is anticipated and does not qualify for exclusion unless deemed true disease progression by the primary treatment team.
- Patients with evidence of extrapulmonary metastatic disease.
- Patients who received therapeutic pulmonary surgery for lung metastasis prior to enrollment.
- All patients and/or their parents or legal guardians must sign a written informed consent.
- All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met.
Participating Clinics
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
GenesisCare USA - Henderson
Sunrise Hospital and Medical Center
Renown Regional Medical Center
Saint Mary's Regional Medical Center
University Medical Center of Southern Nevada
Comprehensive Cancer Centers of Nevada - Central Valley
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Comprehensive Cancer Centers of Nevada
Radiation Oncology Associates
Radiation Oncology Centers of Nevada Central
Comprehensive Cancer Centers of Nevada - Northwest
Carson Tahoe Regional Medical Center
Comprehensive Cancer Centers of Nevada - Henderson
GenesisCare USA - Las Vegas
Las Vegas Cancer Center-Henderson
Comprehensive Cancer Centers of Nevada-Southeast Henderson
Kingman Regional Medical Center
Las Vegas Cancer Center-Medical Center
Radiation Oncology Centers of Nevada Southeast
GenesisCare USA - Fort Apache
GenesisCare USA - Vegas Tenaya
OptumCare Cancer Care at Fort Apache
Comprehensive Cancer Centers of Nevada-Summerlin
Summerlin Hospital Medical Center
Comprehensive Cancer Centers of Nevada-Horizon Ridge
OptumCare Cancer Care at MountainView
Hope Cancer Care of Nevada
OptumCare Cancer Care at Charleston
Hope Cancer Care of Nevada-Pahrump
OptumCare Cancer Care at Seven Hills
Comprehensive Cancer Centers of Nevada - Town Center
Las Vegas Urology - Pecos
Urology Specialists of Nevada - Southwest
Las Vegas Urology - Cathedral Rock
Las Vegas Urology - Pebble
Las Vegas Urology - Sunset
Urology Specialists of Nevada - Northwest
Las Vegas Urology - Green Valley
Urology Specialists of Nevada - Green Valley
Urology Specialists of Nevada - Central