Treatment Based on the Extent of the Osteosarcoma

Treatment for osteosarcoma depends on several factors, including the extent, grade, and location of the cancer, and on a person’s age and overall health.

Localized, resectable osteosarcoma

These cancers have not been found to have spread to other parts of the body, and all of the visible tumor can be removed (resected) completely by surgery.

High grade: Most osteosarcomas are high grade, meaning they will probably grow and spread quickly if not treated. The usual sequence of treatment for these cancers is as follows:

  • Biopsy to establish the diagnosis.
  • Chemotherapy (chemo), usually for about 10 weeks.
  • Surgery to remove the tumor, preferably by the same surgeon who did the biopsy. If cancer is found at the edge of the surgery specimen (meaning some cancer might have been left behind), a second surgery might be done to try to remove any remaining cancer. Radiation therapy might be given to the area as well.
  • More chemo (for up to a year). If the initial chemo killed most of the cancer cells, the same drugs are often given again after surgery. If the initial chemo didn’t work well, different drugs might be tried.

Chemotherapy is a very important part of treatment for these cancers. Even when imaging tests don’t show that the cancer has spread to distant areas, many patients are likely to have very small areas of cancer spread that can’t be detected with tests. If chemo isn’t given, the cancer is more likely to come back after surgery.

In rare cases, surgery might be the first treatment (before chemo), especially for people who are elderly.

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 chemo). However, if the tumor removed by surgery is found to be high grade, chemo might be recommended.

Localized, non-resectable osteosarcoma

These cancers have not been found to have spread to other parts of the body, but they can’t be removed (resected) completely 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 is then removed with surgery. 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 under control and to help relieve symptoms. More chemotherapy might be another option, either instead of or after radiation therapy. If the first chemo regimen didn’t work very well, different chemo drugs might be tried.

Metastatic osteosarcoma

These cancers have already been found to have 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 under control and to help relieve symptoms. More chemotherapy might be another option, either instead of or after radiation therapy. If the first chemo regimen didn’t work very well, different chemo drugs might be tried.

Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option in many cases.

Recurrent osteosarcoma

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 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. If the cancer is resectable, chemo might be given after surgery. If the cancer is not resectable, chemo might be used to try to shrink the tumor(s) and/or relieve symptoms. Radiation therapy may also be used to help keep its growth in check and help relieve symptoms. Some newer targeted therapy drugs might also be an option in some cases, although more research is needed to see how effective these drugs are (see What’s New in Osteosarcoma Research?).

Because these tumors can be hard to treat, clinical trials of newer treatments may be a good option.

 

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 him or her questions about your treatment options.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Bone Cancer. Version 1.2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/bone.pdf on December 5, 2017.

O’Donnell RJ, DuBois SG, Haas-Kogan DA. Chapter 91: Sarcomas of bone. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2014.

Last Medical Review: December 18, 2017 Last Revised: January 31, 2018

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