Osteosarcoma Treatment

Treatment for osteosarcoma often requires collaboration among various specialists, including:

• Orthopaedic oncologists
• Medical oncologists
• Radiation oncologists
• Pathologists
• Rehabilitation specialists

Chemotherapy

• Purpose: Shrinks the tumor, kills microscopic cancer cells, and prevents metastasis.
• Drugs Used: Commonly used chemotherapeutic agents include methotrexate (with leucovorin rescue), doxorubicin, cisplatin, and ifosfamide.
• Approach:
  • Neoadjuvant Chemotherapy: Administered before surgery to reduce tumor size and make surgical removal easier.
  • Adjuvant Chemotherapy: Given after surgery to eliminate any remaining cancer cells.

Surgical Intervention

• Goals: Remove the tumor completely, minimize local recurrence, and preserve as much function as possible.
• Types:
  • Limb-Sparing Surgery: Involves removing the tumor while preserving the limb. Reconstruction may involve bone grafts or prosthetics.
  • Amputation: Required if the tumor is extensive and cannot be removed without compromising vital structures.
  • Rotationplasty: A specialized procedure where a portion of the limb is removed, and the remaining limb is rotated and reattached, often used in children.

Radiation Therapy

• Rarely used as a primary treatment for osteosarcoma, as it is less effective against this type of cancer. However, it may be employed for inoperable tumors or palliation in metastatic cases.

• Targeted Therapy: Involves drugs that target specific molecules involved in cancer growth. Research is ongoing in this area.
• Immunotherapy: Trials are exploring the use of immune checkpoint inhibitors to enhance the immune system's ability to fight osteosarcoma.

Osteosarcoma commonly spreads to the lungs. Surgical removal of lung metastases (metastasectomy) may be performed if they are limited and resectable. Chemotherapy may also be used to address metastatic disease.

• Rehabilitation: Physical therapy and occupational therapy are essential for restoring mobility and function after surgery.
• Follow-Up Care: Regular monitoring through imaging and blood tests is necessary to detect recurrence or metastasis early.

• The survival rate for localized osteosarcoma is about 60-80% when treated with a combination of surgery and chemotherapy.
• For metastatic or recurrent disease, prognosis depends on the extent of spread and response to treatment.

Treatment advancements continue to improve outcomes for osteosarcoma patients, offering hope for higher survival rates and better quality of life.