Osteosarcoma

Osteosarcoma is a rare neoplasm that develops in bone tissue. Our osteosarcoma patients receive efficient, coordinated treatment from a multidisciplinary team of specialists that include pediatric oncologists, medical oncologists, pediatric surgeons, radiation oncologists, orthopedic oncologists, vascular surgeons and rehabilitation experts. Osteosarcoma tumors are often found when an individual experiences pain or swelling in a bone or joint that does not go away completely. For suspected cases of osteosarcoma, physicians evaluate the tumor using imaging studies such as X-rays, CT and MRI scans, and bone scans. To diagnose osteosarcoma, the doctor must remove a small sample of the suspected tumor for examination by a pathologist (biopsy). The pathologist views the sample under a microscope to determine whether the tumor is malignant and to identify the exact type. After completing a thorough evaluation of the patient, the patient care team develops an individualized treatment strategy.

The treatment of osteosarcoma depends upon the location and size of the tumor and the needs of the patient. Osteosarcoma treatment has two goals: to cure the tumor and preserve as much function as possible.

Chemotherapy: A person with osteosarcoma generally receives a combination of cancer-fighting drugs (chemotherapy) followed by surgery on the tumor. Chemotherapy is given to control the spread of the disease and to shrink the tumor, making surgery more manageable.

Surgery: In about 90 percent of osteosarcoma cases of the arm or leg, the limb can be saved. The decision to try to save the limb depends upon the tumor's size, its proximity to adjacent structures and the response to chemotherapy given before surgery.

Limb Salvage Techniques: Limb-salvage techniques include rotationplasty, bone grafts (autografts and allografts) and implantation of prosthetic joints.

Autograft: In this procedure, a surgeon harvests the patient's own bone tissue to implant at the site where tumor is removed. One common technique is called free vascularized fibular grafting. Surgeons harvest the smaller of the two lower leg bones as well as its blood vessels to implant at the cancer site. We have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) techniques include a greater chance for the bone to heal and a reduced chance for infection.

Allograft: Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas after resection of the osteosarcoma tumor. This is called allograft. We have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system.

Rotationplasty: Typically used for young or athletic patients who have osteosarcoma near the knee joint, rotationplasty can allow a patient to run or walk with near-normal function. An orthopedic surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle becomes the "knee." Specialists then fit the patient with a prosthetic ankle and foot.

Prosthetic Implants: Surgeons can replace sections of bone with specialized prosthetic implants. Many different sizes of expandable and solid implants are available. Surgeons consider whether the patient will experience further bone growth before recommending prosthetic implants.

Postoperative Chemotherapy: Following surgery, additional chemotherapy is often recommended to improve the chances that the cancer cells have been eliminated. This chemotherapy course may last eight to 12 months. In general, radiation is used only in osteosarcoma cases where surgery is impossible, unacceptable to the patient or impractical because of the tumor's location or other factors.

Advanced Cases: For individuals whose cancer has spread, treatment is more difficult and depends on tumor location. Osteosarcoma metastases occur more often in the lung than at other sites. Physicians develop individualized treatment programs to control cancer and obtain long-term remission. These approaches may include surgery, radiation and treatments under investigation in clinical trials.  Patients with osteosarcoma lung metastases are usually treated with lung surgery, if possible.