Osteosarcoma surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Surgery

• Cure, if achievable requires aggressive surgical resection often with amputation followed by chemotherapy.
• If a limb-salvage procedure is feasible, a course of multi-drug chemotherapy precedes surgery to downstage the tumor, followed by wide resection of the bone and insertion of an endoprosthesis.
• The outcome depend on different factors such as age, sex, site, size, and type but the most important predictor is the histologic degree of necrosis post induction chemotherapy; 90% histologic necrosis is associated with much better prognosis.

Localized Osteosarcoma

• The cancer is only in the bone where it started and may be in the tissues next to the bone.
• Localized osteosarcomas are further divided into 2 groups: localized resectable osteosarcoma and localized unresectable osteosarcoma.

Localized resectable osteosarcoma

Resectable tumors are those in which all the visible tumor can be removed by surgery and the cancer has not spread to other parts of the body.

• Surgery is the primary treatment for localized resectable osteosarcoma.
• Surgery is usually the only treatment used for low-grade, localized resectable osteosarcomas (chemotherapy is not given).
• The types of surgery done include:
  • Limb-sparing surgery
  • Amputation
  • Reconstruction
  • Rotationplasty
• Chemotherapy may be offered for localized resectable osteosarcoma.
• It is usually given before surgery.
• Chemotherapy is also given after surgery to destroy any remaining cancer cells.

Localized unresectable osteosarcoma

Localized unresectable tumors have not spread to other parts of the body, but they cannot be completely removed by surgery. They may be too large or too close to vital structures in the body to be resected.

• Chemotherapy is usually the first treatment offered for localized unresectable osteosarcoma.
• If the tumour shrinks enough to become resectable, it is then treated with surgery.
• If the osteosarcoma is still unresectable after chemotherapy, radiation therapy may be given to control pain.

• Metastatic Osteosarcoma:

• Lung Metastasis: When osteosarcoma spreads, it usually spreads to the lung. Treatment of osteosarcoma and MFH with lung metastasis may include Combination chemotherapy followed by surgery to remove the primary cancer and the cancer that has spread to the lung.
• Bone Metastasis or Bone with Lung Metastasis: Osteosarcoma spread to a distant bone and/or the lung. Treatment may include Combination chemotherapy followed by surgery to remove the primary tumor and the cancer that has spread to other parts of the body. More chemotherapy is given after surgery. Surgery to remove the primary tumor followed by chemotherapy and surgery to remove cancer that has spread to other parts of the body.

• Recurrent Osteosarcoma of Bone:

• Treatment of recurrent osteosarcoma and malignant fibrous histiocytoma of bone may include the following:
• Surgery to remove the tumor with or without chemotherapy.
• Samarium with or without stem cell transplant using the patient's own stem cells, aspalliative treatment to relieve pain and improve the quality of life.
• A clinical trial of new types of treatment for patients whose cancer cannot be removed by surgery. These may include targeted therapy.