Osteosarcoma with multiple pulmonary nodules treated with zoledronic acid in addition to conventional chemotherapy

Abstract

Osteosarcoma (OS) is the most common malignant bone tumor in children. Patients without metastasis are curable, whereas those with metastasis have a dismal prognosis. A recent clinical test has shown that bisphosphonate inhibits metastasis and improves the survival of osteosarcoma patients. We encountered the case of a 14-year-old male who suffered from OS of the left femur with multiple pulmonary nodules and treated with zoledronic acid (ZA) in addition to conventional chemotherapy. Histopathological examinations of the resected tumor revealed complete necrosis, suggesting a good response to preoperative chemotherapy. After the completion of chemotherapy, a few nodules disappeared, although most of the remaining pulmonary nodules showed no change in shape. Only hematological toxicity was observed during chemotherapy with ZA. The addition of ZA to conventional chemotherapy was safe in our patient. Evaluation of ZA efficacy was difficult, because the possibility that the pulmonary nodules were physiological intrapulmonary lymph nodes was high. Further experiences of treating Japanese patients will clarify the safety and efficacy of bisphosphonate for OS.