Radiological nodule behavior: A critical parameter in the surgical management of pediatric pulmonary metastases

Özet

Radiological nodule behavior (RNB) means the course of nodule appearance onconsecutive CT scans. In this study, we aimed to discuss the effects of RNBon prognosis of patients with pulmonary metastasis. Retrospective analysisof patients who underwent pulmonary metastasectomy (PM) between 2005-2015 was performed. RNBs were grouped as stable, enlarging or new risingnodules. The effects of RNBs were analyzed on recurrence, 1- and 3-yearevent free survival (EFS) and mortality.Twenty-seven patients (18 male) underwent PM with a median age of 15years (3-18 years). The diagnoses were listed as osteosarcoma (13), Wilms’tumor (7), Ewing’s sarcoma (3), synovial sarcoma (2), rabdomyosarcoma(1) and mixed germ cell tumor of testis (1). RNBs were new rising in 15patients (55%), enlarging in seven patients (26%) and stable in five patients(19%). Vital tumor metastasis was detected in all of the patients withenlarging nodules (100%); in 10 of the 15 patients with new rising nodules(66%) and none of the patients with stable nodules. None of the patientswith stable nodules developed recurrence or died after PM (p˂0.05). Inpatients with enlarging nodules, metastases recurred and they died in thepostoperative period. These findings were similar in different types of tumors.RNB could be used as a critical parameter in deciding surgical managementstrategies of pulmonary metastases. Stabile nodules should be observed byclose follow-up with serial CT scans without surgery. All of the suspectednew rising nodules should undergo surgical sampling to avoid unnecessarychemotherapy. Nodule progression under chemotherapy is a poor prognosticcriteria for overall survival.