Alterations in the pattern of pulmonary metastasis of patients with osteosarcoma treated with adjuvant chemotherapy were studied. Thirty two patients who were treated with both radical surgery and adjuvant chemotherapy were observed (chemotherapy group). As a control, sixty two patients treated with radical surgery alone were also assessed (non-chemotherapy group). The chemotherapy group demonstrated a reduction in the number and a delay in the appearance of metastases. The tumour doubling time did not differ between the chemotherapy and non-chemotherapy groups. The initial site of metastasis among the chemotherapy group was most commonly in the lower lung field, whereas among the non-chemotherapy group it was usually to the middle lung field. The chemotherapy group survived longer than the non-chemotherapy group after developing pulmonary metastases. Histological examination showed that the metastatic foci stimulated the primary sites.
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