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Treating Osteosarcoma
If you or your child has been diagnosed with osteosarcoma, the cancer care team will discuss treatment options with you. It is important to weigh the benefits of each option against the possible risks and side effects.
How is osteosarcoma treated?
The treatment for osteosarcoma depends on the location, spread, and stage of the tumor. Osteosarcoma is almost always treated with both local treatment (surgery and/or radiation therapy) as well as chemotherapy (chemo).
Common approaches to treating osteosarcoma
The most important factors that help determine what treatment is best are:
- The location of the cancer
- If the cancer can be removed with surgery
- Whether the cancer has extended outside the bone it started in
- The stage of the cancer
- If the cancer has responded to previous treatments or not
Approaches to treatment based on these factors are described below.
These cancers have not spread to other parts of the body, and all of the visible tumor can be removed (resected) by surgery.
High grade: Most osteosarcomas are high grade, meaning they spread quickly. When patients are diagnosed, even without tumors elsewhere in the body on imaging tests, cancer is often present in other parts of the body (microscopic disease). Most often, chemotherapy (chemo) is given both before and after surgery. It can help lower the risk that the cancer will come back after treatment. It might also allow the surgeon to do a less extensive operation to remove the cancer. In rare cases, surgery might be the first treatment (before chemo), especially for people who are elderly. Radiation therapy is not typically used for resectable osteosarcomas.
Low grade: A small number of osteosarcomas are low or intermediate grade, meaning they are likely to grow slowly. Patients with low-grade, resectable osteosarcomas can often be cured with surgery alone (without chemo). However, if the tumor removed by surgery is found to be high grade on lab tests, chemo might be recommended.
These cancers have not spread to other parts of the body, but they cannot be removed (resected) completely by surgery. For example, they may be too large or too close to important nerves or blood vessels in the body to be removed completely.
Chemotherapy (chemo) is usually the first treatment for these cancers after a biopsy confirms the diagnosis. If the tumor shrinks enough to become resectable, it is then removed with surgery. This is followed by more chemo after surgery.
If the tumor still cannot be removed completely after chemo, radiation therapy can often be used to try to kill remaining cancer cells. More chemo might be another option, either instead of or after radiation therapy. If the first chemo regimen did not work very well, other chemo drugs might be tried.
Because these tumors can be hard to treat, clinical trials of newer treatments may provide other treatment options.
These cancers have spread to distant parts of the body when they are diagnosed. Most often, they have spread to the lungs.
Chemotherapy (chemo) is usually the first treatment for these cancers once a biopsy confirms the diagnosis. If all of the tumors are thought to be resectable after chemotherapy, they are removed with surgery. It may take more than one operation. This is followed by more chemo after surgery.
If some of the tumors remain unresectable after chemo, radiation therapy can often be used to kill remaining cancer cells. More chemo might be another option, either instead of or after radiation therapy. If the first chemo regimen did not work very well, other chemo drugs might be tried.
Newer targeted therapy drugs such as regorafenib (Stivarga), sorafenib (Nexavar), or cabozantinib (Cabometyx) might be an option as well.
Because these tumors can be hard to treat, clinical trials of newer treatments may provide other treatment options.
Recurrent cancer means that the cancer has come back after treatment. It may come back locally (near where the first tumor was) or in other parts of the body. Most of the time, if osteosarcoma recurs it will be in the lungs.
If possible, surgery to remove the tumor(s) is an important part of 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 is often part of the treatment for recurrent cancers as well. If the cancer is not resectable, chemo might be used to try to shrink the tumor(s), which might then allow surgery to be done. If the cancer is resectable, chemo might be given after surgery. For more advanced cancers, chemo might be used to help relieve symptoms.
Radiation therapy might be part of treatment as well. It can sometimes help slow or stop tumor growth and help relieve any symptoms.
Newer targeted therapy drugs such as regorafenib (Stivarga), sorafenib (Nexavar), or cabozantinib (Cabometyx) might be an option as well.
Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option.
Who treats osteosarcoma?
Osteosarcoma is rare, and treating it can be complex. It is important for people with osteosarcoma to be treated by a team of doctors experienced with bone tumors.
A team approach is recommended when treating osteosarcoma. For children and teens, treatment is best done at a children’s cancer center. For adults with osteosarcoma, treatment is typically done at a major cancer center. Doctors on the treatment team might include:
- An orthopedic surgeon (a surgeon who specializes in muscles and bones) who is experienced in treating bone tumors
- A medical or pediatric oncologist (a doctor who treats cancer with chemotherapy and other drugs)
- A radiation oncologist (a doctor who treats cancer with radiation therapy)
- A physiatrist (a doctor specializing in rehabilitation and physical therapy)
For both adults and children, the team might also include other doctors, physician assistants (PAs), nurse practitioners (NPs), nurses, psychologists, social workers, physical therapists and other rehabilitation specialists, and other health professionals.
Learn more in Who Is the Cancer Care Team? and How to Find the Best Cancer Treatment for Your Child.
Making treatment decisions
Treatment for osteosarcoma is often effective, but it can also cause serious side effects.
It is important to discuss all treatment options, as well as their possible side effects, with the cancer care team so you can make the decision that is the best fit for you or your child. If there is anything you do not understand, ask to have it explained.
Learn more in Talking to Your Child’s Cancer Care Team.
Questions to ask before osteosarcoma treatment
Understanding the diagnosis and choosing a treatment plan
- What are our treatment options?
- What do you recommend and why?
- Are there any clinical trials we should consider? How can we find out more about them?
- What’s the goal of treatment?
- What are the chances of curing osteosarcoma with this treatment?
- Should we get a second opinion? How do we do that? Can you recommend a doctor or cancer center?
- How soon do we need to start treatment?
- What will our options be if the treatment does not work or if the osteosarcoma comes back? What should we do to be ready for treatment?
- Could my family members be at risk of having osteosarcoma? Should we get testing?
What to expect during treatment
- How long will treatment last? What will it be like? Where will it be done?
- How will we know if the treatment is working?
- Will the treatment be given in the hospital, clinic, or at home?
- Can I attend work or school during treatment? How will treatment affect our daily life?
Side effects and long-term effects
- What are the possible risks and side effects of the treatments you recommend?
- Which side effects start shortly after treatment, and which ones might develop later on?
- Is there anything we can do to help manage or avoid side effects?
- What symptoms or side effects should we tell you about right away?
- How can we reach you or someone on your team on nights, weekends, or holidays?
- Can treatment affect my (child’s) fertility? Is there anything we can do to preserve fertility before or after treatment?
Support and resources
- Who can we talk to if we have questions about costs, insurance coverage, or social support?
- What type of follow-up and rehab will be needed after treatment?
- Do you know of any local or online support groups where we can talk to other families who have been through this?
Other things to consider
- If time allows, consider getting a second opinion to feel more confident about the treatment plan you choose.
- Clinical trials study new treatments and may offer access to promising options not widely available. They are also how doctors learn better ways to treat cancer. Ask your doctor about clinical trials you may qualify for.
- You may hear about ways to relieve symptoms or treat your cancer such as herbs, diets, acupuncture, massage, or others. Integrative (holistic) methods are used along with standard care, while alternative methods are used instead of standard care. Some may help with symptoms, but many aren’t proven to work and could even be harmful. Talk with your care team first to make sure they’re safe and won’t interfere with your treatment.
Preparing for treatment
Before treatment, the doctors and other members of the team will help you understand the tests that need to be done.
You or your child’s cancer care team will also often include a social worker. The team’s social worker will be there to support you and your family before, during, and after treatment. Adjusting to a new cancer diagnosis and its treatment plan can be tough, but your cancer care team is there to help.
Learn more in Helping Your Child Adjust to a Cancer Diagnosis.
Social and emotional health during treatment
Social and emotional distress may come up during and after treatment.
It can be normal to have some anxiety or other emotions about cancer and its treatment, but feeling overly worried, depressed, or angry can affect your health. It can get in the way of relationships, school, work, and other aspects of life. With support from family, friends, other survivors, mental health professionals, and others, many people who have survived cancer can thrive despite the challenges they have had to face.
Osteosarcoma and its treatment can have a profound effect on how a person views themselves and their body. It can also affect how they do some everyday tasks, including certain school, work, or recreational activities. Some people may also have a hard time coping with being away from work, friends, and activities they enjoyed before cancer. These impacts are often greatest during the first year of treatment, but they can be long-lasting in some people.
Self-esteem, self-image, and social development can be addressed with support and encouragement. Many cancer centers have special support programs and services to help people with cancer and their families during treatment and for many years after treatment ends. Reach out to your cancer center for help when needed. This may include services like counseling, social events, or support groups.
Children and adolescents
People diagnosed in childhood or adolescence may have unique needs during and after treatment. Depending on their age, they may also have some problems with relationships and keeping up with school.
Many experts recommend that school-aged patients attend school as much as they can. This can help them maintain a routine and tell their friends about what is happening.
Friends can be a great source of support, but patients and parents should know that some people may have wrong ideas about cancer and fears of their own. Some cancer centers have school re-entry programs that can help in these situations. In these programs, health educators visit the school and tell students about cancer, its treatment, and what changes they may notice in their classmate. They also answer any questions their class might have. (For more information, see Going to School During and After Cancer Treatment.)
Family members
Parents, siblings, and other family members can also be affected, both emotionally and in other ways. Some common family concerns during treatment include financial stresses, traveling to and staying near the cancer center, the need to take time off from work, and the need for homeschooling. Social workers and others at your treating center can help sort through these issues.
Centers that treat many children with cancer may have programs to introduce new patients and their families to others who have finished their treatment. This can give them an idea of what to expect during and after treatment, which can be very important.
Help getting through cancer treatment
Your cancer care team will be your first source of information and support, but there are other resources for help when you need it. Hospital- or clinic-based support services can also be an important part of your care. These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help. For children and teens with cancer and their families, other specialists can be an important part of care as well.
The American Cancer Society also has programs and services – including rides to treatment, lodging, and more – to help you get through treatment. Call our National Cancer Information Center at 1-800-227-2345 and speak with one of our trained specialists.
The treatment information given here is not official policy of the American Cancer 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 your cancer care team any questions you may have about your treatment options.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Anderson ME, Dubois SG, Gebhart MC. Chapter 89: Sarcomas of bone. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.
Janeway K, Randall R, Gorlick R. Chapter 28: Osteosarcoma. In: Blaney SM, Adamson PC, Helman LJ, eds. Pizzo and Poplack’s Pediatric Oncology. 8th ed. Philadelphia Pa: Lippincott Williams & Wilkins; 2021.
National Cancer Institute. Osteosarcoma and Undifferentiated Pleomorphic Sarcoma of Bone Treatment (PDQ). 2024. Accessed at https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq on June 3, 2025.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Bone Cancer. Version 2.2025. Accessed at www.nccn.org/professionals/physician_gls/pdf/bone.pdf on June 3, 2025.
Last Revised: August 21, 2025
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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