Treatment based on the extent of the osteosarcoma
Treatment for osteosarcoma depends on several factors, including the extent, location, and grade of the cancer, and on a person’s overall health.
Localized, resectable osteosarcoma
These cancers have not spread to other parts of the body, and all of the visible tumor can be completely removed (resected) by surgery.
High grade: Most osteosarcomas are high grade, meaning they may grow and spread quickly if not treated. The usual sequence of treatment for these cancers is as follows:
- Biopsy to establish the diagnosis
- Chemo (usually for about 10 weeks)
- More chemo (for up to a year)
Chemotherapy is an important part of treatment for these cancers. Even when imaging tests do not show that the cancer has spread to distant areas, some patients are likely to have micrometastases (very small areas of cancer spread that can’t be detected with tests). If chemotherapy isn’t given, the cancer is more likely to come back after surgery.
Low grade: A small number of osteosarcomas are low grade, meaning they are likely to grow slowly. Patients with low-grade, resectable osteosarcomas can often be cured with surgery alone (without chemotherapy). Studies have shown that these patients do just as well having surgery without chemo.
However, if after surgery the tumor is found to be high grade by the pathologist, chemotherapy will be recommended.
Localized, non-resectable osteosarcoma
These cancers have not spread to other parts of the body, but they can’t be completely removed by surgery. For example, they may be too large or too close to vital structures in the body to be resected completely. As with other osteosarcomas, a biopsy is needed first to establish the diagnosis.
Chemotherapy is usually the first treatment for these cancers. If the tumor shrinks enough to become resectable it will be removed surgically. This is followed by more chemotherapy for up to a year.
If the tumor is still unresectable after chemotherapy, radiation therapy can often be used to try to keep the tumor in check and to help relieve symptoms. This may be followed by more chemotherapy.
These cancers have already spread to distant parts of the body when they are diagnosed. Most often they have spread to the lungs. As with other osteosarcomas, a biopsy is needed first to establish the diagnosis.
Chemotherapy is usually the first treatment for these cancers. If all of the tumors are thought to be resectable after chemotherapy, they are removed with surgery, sometimes in more than one operation. This is followed by more chemo for up to a year.
If some of the tumors remain unresectable after chemo, radiation therapy can often be used to try to keep them in check and to help relieve symptoms. This may be followed by more chemo.
Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option in many cases.
Recurrent cancer means that the cancer comes back after treatment. It may come back locally (near where the first tumor was) or in distant organs. Most of the time, if osteosarcoma recurs it will be in the lungs.
If possible, surgery to remove the tumor(s) is the preferred treatment, as it offers the best chance for long-term survival. If the cancer recurs at the original site on an arm or leg after limb-sparing surgery, amputation of the limb may be recommended.
Chemotherapy may be used for recurrent cancers as well, although its role in these cases is not clearly defined. If the cancer is not resectable, radiation therapy may also be used to help keep its growth in check and help relieve symptoms. Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option.
Last Medical Review: 01/08/2013
Last Revised: 02/06/2014