This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

There has been great progress in the treatment of osteosarcoma during the last 30 years. In the 1960s the only treatment was amputation. At that time, only 5% to 20% of patients lived for 2 or more years after their cancer was found. Since then, doctors have found that chemo given before and after surgery will cure many people with this cancer. It may also allow some people to avoid having an arm or leg removed.

After the cancer is found and staged, the doctor will suggest a treatment plan. This is an important decision and it is a good idea to take time and think about all the choices. Because osteosarcoma is rare, few doctors except those in major cancer centers have much experience in treating this disease. The best approach involves a team of people that includes several doctors as well as other experts who work together to find and treat the disease and help you get back to normal activities after surgery.

Surgery

Surgery for this type of cancer includes the biopsy and the surgery itself. It is very important that they are planned together. If possible, both should be done by the same surgeon at a major cancer center. Some tumors are much harder to treat. Examples include tumors at the base of the skull, or in the spine or pelvis. In those cases, a cure is not likely even if the cancer responds well to chemotherapy.

Surgery can be either the kind that saves the limb (limb-sparing) or amputation (removing the cancer and all or part of an arm or leg).

Limb-sparing surgery or limb-salvage surgery: This type of surgery is very complex and should be done by a doctor with special skill and experience. The challenge for the surgeon is to remove all of the tumor while saving the nearby tendons, nerves, and blood vessels. The bone that is removed is replaced with a bone graft or with a metal rod. Some metal rods are designed to grow with the child and can be made longer without any extra surgery. They have tiny devices in them that can lengthen the "bone" whenever needed to make room for a child's growth.

About 50% to 80% of patients are able to have their limbs spared. Ask the surgeon to explain the best way to remove the cancer and keep as much use of the involved arm or leg as possible.

Patients may need more surgery during the 5 years after the first operation, and some patients might still need an amputation later on. There can be a danger of infection and grafts or rods can become loose or break. It takes about a year, on average, for patients to learn to walk again after this surgery on a leg. If the person does not keep up with rehabilitation, the arm or leg may become useless.

Amputation: If there is a large tumor that involves the nerves or the blood vessels, an amputation might be the only choice. Surgery is planned so that muscles and the skin will form a cuff around the end of the arm or leg. This cuff will fit into an artificial limb (prosthesis). With proper physical therapy, the patient is often walking within 3-6 months after a leg amputation.

Reconstructive surgery: Sometimes, if the bone has to be removed in the middle of the thigh, the lower leg and foot is turned and attached to the thigh bone. The ankle now functions as a knee joint. Of course, the person will need an artificial leg to make the leg long enough.

If the cancer is in the upper arm, the tumor may be removed and the lower arm reattached. Then the person will have a working, but shorter, arm. If the cancer is in the lower jaw bone, the entire lower half of the jaw may be removed and replaced with bones from other parts of the body.

Rehabilitation after surgery: This might turn out to be the hardest part of all. Patients (and their parents, if the patient is a child) must meet with a rehabilitation expert to learn what must be done. If a limb has been removed, the person must learn how to deal with the artificial limb. This can be hard for growing children when the artificial limb needs to be changed to keep up with their growth. There are some devices that can be lengthened to keep up with the growth of children.

If limb-sparing surgery is done, the situation is even more complex. One thing that can be done is to use bone grafts from donors to replace the removed bone. Another is to put in a metal prosthesis. Some of these can be expanded to keep up with the child's growth.

Each of these surgeries has problems as well as benefits. It turns out that there is little difference in the approaches in terms of how people react and quality of life. Perhaps the biggest problem has been for teenagers who fear the social effects of their operation. These feelings and concerns are very important and support and encouragement are needed for all patients.

Surgery for metastases: Surgery to remove cancer that has spread to the lungs must be planned very carefully. Taking out the lung metastases will give the patient the only chance for a cure. But the doctor must have a plan in case there are more tumors than the CT scan showed. There could be some areas of spread that cannot be removed because they are too big or are too close to structures in the chest, such as big blood vessels. Also, some patients may not be healthy enough to go through such surgery.

Chemotherapy

Chemo is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they go throughout the body, which makes this a useful treatment for osteosarcoma that has spread to the lungs or other organs. Often, chemo is given both before and after surgery. And most of the time 2 or 3 drugs are given together.

Side effects of chemo

Chemo kills cancer cells, but it will also damage some normal cells. Side effects from chemo will depend on the type of drugs given, the amount taken, and how long treatment lasts. These side effects could include:

• nausea and vomiting
• loss of appetite
• hair loss (the hair grows back after treatment ends)
• mouth sores
• increased chance of infection (caused by a shortage of white blood cells)
• bleeding or bruising after small cut or injuries (from a shortage of platelets)
• tiredness or shortness of breath (from a shortage of red blood cells)

Chemo may rarely cause a second type of cancer (such as leukemia) years after the osteosarcoma is cured. But the importance of chemo in treating osteosarcoma far outweighs this risk. Some side effects, such as damage to the heart and infertility (not being able to have children), happen with certain drugs. Serious side effects are rare, but they do happen. Side effects can often be prevented or controlled. Anyone who has problems with side effects should talk with their doctor or nurse about them.

Tests to check for side effects of chemo: Before giving chemo, your doctor will check your lab results to be sure your liver, kidney, and bone marrow (which makes blood cells) are working well.

The complete blood count (CBC) includes counts of white blood cells, red blood cells, and blood platelets. White blood cells fight infections, so it is important to know the white blood cell count before chemo starts. Platelets are small cells that plug up holes in blood vessels and stop bleeding. Red blood cells carry oxygen from the lungs to the rest of your body.

Routine blood chemistry panels measure certain blood chemicals that tell doctors how well the liver and the kidneys are working.

Radiation treatment

Radiation therapy is treatment with high-energy rays to kill cancer cells. For the most part radiation is not used to treat this cancer. Sometimes, though, it may be useful when the tumor cannot be completely removed by surgery. It can also help control some symptoms like pain and swelling if the cancer has come back and surgery is not an option.

If osteosarcoma comes back (recurrent disease)

Recurrent cancer means that the cancer has come back after treatment. When osteosarcoma comes back it is most often in the lungs. When possible, these tumors should be removed. Chemo may be used after surgery for a recurrence. Clinical trials may also be an option.

Survival rates for osteosarcoma

The overall survival rate for people with osteosarcoma that hasn't spread is over 70%. With a good response to chemo, the survival rate is even better (about 80% to 90%). The 5-year survival rate for patients whose cancers have already metastasized at the time it is found is about 30%.

Last Medical Review: 03/20/2007
Last Revised: 03/20/2007