- Standard Treatment
- Clinical Trials
- Treatment By Stage
How osteosarcoma is treated
Different types of treatment are available for children with osteosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
If it is suspected that the problem is osteosarcoma, before the first biopsy, your doctor may recommend a specialist called an orthopedic oncologist.
Three kinds of standard treatment are used:
- Surgery (taking out the cancer in an operation).
- Chemotherapy (using drugs to kill cancer cells).
- Radiation therapy (using high-dose x-rays to kill cancer cells).
In addition to these standard therapies, a treatment called biologic therapy is being tested for localized and metastatic osteosarcoma. Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
All patients with localized osteosarcoma should have surgery to remove the tumor, if possible. The doctor may remove only the cancer and some of the healthy tissue around the cancer (limb-sparing surgery). When the tumor is in a weight-bearing bone, the bone should be protected during activity to avoid fractures that could prevent limb-sparing surgery. Sometimes all or part of an arm or leg may have to be removed (amputated) to make sure that all of the cancer is taken out. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).
In patients with osteosarcoma that has not spread beyond the bone, researchers have found no difference in overall survival whether patients have limb-sparing surgery or whether they have surgery with amputation. When the cancer can be taken out without amputation, artificial devices or bones from other places in the body can be used to replace the bone that was removed. The process of rebuilding (reconstructing) a part of the body changed by previous surgery is called reconstructive surgery. Options for reconstructive surgery in patients with osteosarcoma depend on many factors, including where the tumor is, how large it is, the age of the patient, and how much the patient will continue to grow.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill or put into the body by a needle in a vein or muscle. Chemotherapy is called systemic treatment because the drug enters the blood stream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy with more than one drug is called combination chemotherapy.
Sometimes chemotherapy is injected directly into the area where the cancer is found (regional chemotherapy). In osteosarcoma, surgery is often used to remove the local tumor and chemotherapy is then given to kill any cancer cells that remain in the body. Chemotherapy given after surgery has removed the cancer is called adjuvant chemotherapy. Chemotherapy can also be given before surgery to shrink the cancer so that it can be removed during surgery; this is called neoadjuvant chemotherapy.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for osteosarcoma usually comes from a machine outside the body (external radiation therapy).
Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
Treatment in a clinical trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. In the following lists of treatments for the different stages, a link to search results for current clinical trials is included for each section. These have been retrieved from NCI's clinical trials database. For some types or stages of cancer, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but that may be right for your child.
Localized Osteosarcoma and Malignant Fibrous Histiocytoma of Bone
Treatment of osteosarcoma may be the following:
- Neoadjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy.
- Clinical trials of new methods of giving chemotherapy and new schedules of treatment.
- A clinical trial of high-dose radiation therapy with or without chemotherapy.
- A clinical trial of chemotherapy with or without biologic therapy.
Treatment of malignant fibrous histiocytoma of bone may be the following:
- Neoadjuvant chemotherapy followed by wide local excision of the tumor.
Treatment of osteosarcoma that develops following radiation therapy includes chemotherapy and surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized osteosarcoma and localized childhood malignant fibrous histiocytoma of bone.
Metastatic Disease at Diagnosis
Metastatic disease is cancer that has spread from the place in which it started to other parts of the body. When the cancer has spread to the lungs, the prognosis is better if the cancer is in only one lung and in fewer places in the lung. For cancer that has spread to the bone, prognosis is better if the tumors are all in the same bone.
Treatment of osteosarcoma with metastasis may be one of the following:
- Chemotherapy followed by surgery to remove the cancer followed by adjuvant chemotherapy.
- Surgery to remove the cancer followed by adjuvant chemotherapy.
- A clinical trial of chemotherapy with or without biologic therapy.
Surgery often includes removal of cancer that has spread to the lungs.
Malignant fibrous histiocytoma of bone
Treatment of malignant fibrous histiocytoma of bone with metastasis is the same as for osteosarcoma with metastasis.
Treatment of multifocal osteosarcoma includes chemotherapy and surgery.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with metastatic osteosarcoma and metastatic childhood malignant fibrous histiocytoma of bone.
Treatment depends on where the cancer recurred, what kind of treatment was given before, as well as other factors. A clinical trial may be a reasonable treatment option.
If the cancer has come back only in the lungs, treatment may be surgery to remove the cancer in the lungs with or without chemotherapy. If the cancer has come back in other places besides the lungs, treatment may be combination chemotherapy. Clinical trials are evaluating new chemotherapy drugs and peripheral stem cell support as palliative therapy, to relieve pain and improve quality of life.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent osteosarcoma and recurrent childhood malignant fibrous histiocytoma of bone.