Osteosarcoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Medical Therapy

Family physicians and orthopedists rarely see a malignant bone tumor (most bone tumors are benign). Thus, many patients are initially misdiagnosed with cysts or muscle problems, and some are sent straight to physical therapy without an x-ray.

The route to osteosarcoma diagnosis usually begins with an x-ray, continues with a combination of scans (CT scan, PET scan, bone scan, MRI) and ends with a surgical biopsy. Much can be seen on films, but the biopsy is the only definitive proof that a bone tumor is indeed malignant or benign.

The biopsy of suspected osteosarcoma should be performed by a qualified orthopedic oncologist. The American Cancer Society states: "Probably in no other cancer is it as important to perform this procedure properly. An improperly performed biopsy may make it difficult to save the affected limb from amputation."

General Treatment

Patients with osteosarcoma are best managed by a medical oncologist and an orthopedic oncologist experienced in managing sarcomas. Current standard treatment is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection. The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regime should be altered after surgery.

Standard therapy is a combination of limb-salvage orthopedic surgery and a combination of high dose methotrexate with leucovorin rescue, intra-arterial cisplatin caffeine, adriamycin, ifosfamide with mesna, BCD, etoposide, muramyl tri-peptite (MTP).

Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low.

3-year event free survival ranges from 50% to 75%. and 5-year survival ranges from 60% to 85+% in some studies. Overall, 60-65% treated 5-years ago (2000) will be alive today. Osteosarcoma has one of the lowest survival rates for pediatric cancer despite chemotherapy's success in osteosarcoma of 6 chemotherapies, interferon-alpha, interleukin-2, and being the prototype of solid tumors in cancer.

Treatment studies come from Children's hospital Boston, Memorial Sloan-Kettering, Children's Oncology Group, Italian Oncology Group, Japan, and MD Anderson in Texas.

Fluids are given for hydration.

Drugs like Kytril and Zofran help with nausea and vomiting.

Neupogen, epogen, Neulasta help with white blood cell counts and neutrophil counts.

Blood helps with anemia.