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Background Repeat pulmonary metastasectomy (PM) considerably improves the prognosis of patients with pulmonary metastases of osteosarcoma. Reports have demonstrated a significantly improved prognosis in patients who have undergone repeat metastasectomy for osteosarcoma; however, there have been no reports with more than six metastasectomies. Herein, we describe the long-term survival of a patient following resection of multiple tumors and other treatments for metastatic osteosarcoma. Case presentation A 28-year-old woman underwent extensive resection and postoperative adjuvant chemotherapy for right tibial sarcoma. Over the years, she developed repeated pulmonary metastases. First, 116 metastases were removed from the bilateral lungs. After that, multiple PMs of approximately 250 tumors and other treatments for deep metastatic lesions were performed. The patient died of the underlying disease 24 years after the primary surgery. Conclusions This case report demonstrates the long-term survival benefit of a multidisciplinary treatment centered on multiple metastasectomies.

Background Although osteoblastoma is an uncommon benign bone tumor, it sometimes behaves in a locally aggressive fashion. We herein report a case of recurrent lumbar spine osteoblastoma that was treated by repeated surgery and carbon ion radiotherapy. Case presentation A 13-year-old Japanese girl presented with left side lumbar pain. Computed tomography and magnetic resonance imaging of the lumbar spine demonstrated a tumorous lesion in the left side pedicle of L4. Although gross total resection of the mass, including the nidus, was performed in the initial surgery, recurrence was observed repeatedly in the short term and the pathological diagnosis of all of the resected tumors was conventional osteoblastoma. We finally performed carbon ion radiotherapy after the patient’s 3rd palliative operation, and achieved a good outcome. No further recurrence has been observed in 10 years of follow-up. Conclusion We performed carbon ion radiotherapy for a case of recurrent spinal osteoblastoma and achieved a good outcome without recurrence at 10 years after carbon ion radiotherapy treatment. To the best of our knowledge, this is the first case of osteoblastoma that was treated with carbon ion radiotherapy after multiple surgeries.