Advanced Management of Refractory Bronchopleural Fistula in Pulmonary Osteosarcoma Metastasis: Individualized Application of Interventional Therapy

Background Bronchopleural fistula is a life-threatening complication of pulmonary metastasis of osteosarcoma with limited therapeutic options. This study aimed to evaluate the efficacy and safety of interventional occlusion for the treatment of refractory bronchopleural fistula. Methods Data of 21 patients with bronchopleural fistula associated with pulmonary metastasis of osteosarcoma between January 2019 and December 2023 were analyzed retrospectively. Technical success, clinical success and survival were evaluated. Results All 21 patients (25 years ± 11, 14 men) received interventional therapy and underwent a total of 27 interventional embolization treatments, of which 21 (77.8%) were successfully embolized with coils and n-Butyl Cyanoacrylate (NBCA) and the instantaneous drainage speed decreased from a preoperative median of 365 ml/min (range: 60–1800) to a postoperative median of 20 ml/min (range: 0–100). 14 (66.7%) reported varying degrees of improvement in their respiratory symptoms, and nearly half of them reached the level of cure, which means that the drainage tube is no longer needed and the lungs are significantly enlarged. 3 patients (14.3%) experienced coughing out of embolization coils. 1 patient (4.7%) experienced postoperative hemoptysis (50ml) but received prompt and effective treatment. Conclusion Individualized interventional therapy, primarily including the use of coils and NBCA for embolization, is an effective and safe method for treating bronchopleural fistula associated with pulmonary metastases from osteosarcoma.