Materiały źródłowe

• #1 Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000603/

  Osteosarcoma is the most common primary malignant bone tumor in children and young adults. The standard-of-care curative treatment for osteosarcoma utilizes doxorubicin, cisplatin, and high-dose methotrexate, a standard that has not changed in more than 40 years. […] Current treatment strategies for osteosarcoma are neoadjuvant chemotherapy with cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate with leucovorin rescue, followed by surgical resection and adjuvant chemotherapy. […] The current treatment regimen for osteosarcoma involves the use of cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate. High-dose methotrexate has demonstrated significant toxicity in the liver, kidney, and brain, and novel therapies that are more specifically targeted to osteosarcoma are needed.

• #2 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #3 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The delivery of systemic therapy in addition to local treatment is necessary to maximize a patients chance of cure. Most patients diagnosed with localized osteosarcoma actually have micrometastases that are undetectable by current procedures. […] The multi-modality approach to treatment for osteosarcoma requires that patients be treated by a multi-disciplinary team consisting of the primary care physician, an orthopedic surgeon experienced in bone tumors, a pathologist, radiation oncologists, pediatric oncologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others. […] The ultimate goal of surgery for localized osteosarcoma is to remove the cancer without amputation. […] Even with the advent of chemotherapy as systemic treatment, surgery is still an important component of treatment for osteosarcoma.

• #4 Osteosarcoma and UPS of Bone Treatment – NCI

  https://www.cancer.gov/types/bone/patient/osteosarcoma-treatment-pdq

  Osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone are diseases in which cancer cells form in bone. […] Osteosarcoma and UPS are treated the same way. […] Treatment options for osteosarcoma and UPS depend on: where the tumor is in the body and if it has spread, the size of the tumor, the grade of the cancer, whether the bones are still growing, your child’s age and overall health, your child’s and family’s goals, such as being able to participate in sports, or concerns about physical appearance, whether the cancer is newly diagnosed or has recurred after treatment. […] There are different types of treatment for children with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS). […] Children with osteosarcoma or UPS should have their treatment planned by a team of health care providers who are experts in treating cancer in children.

• #5 Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000603/

  Osteosarcoma is the most common primary malignant bone tumor in children and young adults. The standard-of-care curative treatment for osteosarcoma utilizes doxorubicin, cisplatin, and high-dose methotrexate, a standard that has not changed in more than 40 years. […] Current treatment strategies for osteosarcoma are neoadjuvant chemotherapy with cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate with leucovorin rescue, followed by surgical resection and adjuvant chemotherapy. […] The current treatment regimen for osteosarcoma involves the use of cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate. High-dose methotrexate has demonstrated significant toxicity in the liver, kidney, and brain, and novel therapies that are more specifically targeted to osteosarcoma are needed.

• #6 Treating Osteosarcoma | Osteosarcoma Treatments | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating.html

  If you or your child has been diagnosed with osteosarcoma, the cancer care team will discuss treatment options with you. Its important to weigh the benefits of each option against the possible risks and side effects. […] Three main types of treatment are used for osteosarcoma: Surgery for Osteosarcoma, Chemotherapy and Other Drugs for Osteosarcoma, Radiation Therapy for Osteosarcoma. […] Most often, chemotherapy 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. Radiation therapy is used less often. […] A team approach is recommended when treating osteosarcoma. For children and teens, this team includes the childs pediatrician as well as childrens cancer specialists. Treatment is best done at a childrens cancer center. For adults with osteosarcoma, the treatment team typically includes the patients primary care doctor, as well as specialists at a major cancer center.

• #7 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  Osteosarcoma, the most common bone cancer, most often occurs in children and adolescents. […] Use of neoadjuvant and adjuvant chemotherapy, in combination with surgery, has improved survival rates to nearly 80% for patients with localized disease, and 90% to 95% of patients do not require limb amputation. […] The current mainstay of treatment for osteosarcoma is neoadjuvant chemotherapy, followed by surgical resection and adjuvant chemotherapy. […] The current five-year survival rate is more than 70% in persons with nonmetastatic disease. […] Neoadjuvant chemotherapy regimens aim to cause tumor necrosis and decrease primary tumor size, as well as the number and size of pulmonary metastases. […] Surgical excision is the definitive treatment for osteosarcoma. […] Currently, 90% to 95% of patients with extremity osteosarcoma avoid amputation with successful limb-sparing resections. […] Osteosarcoma most often metastasizes to the pulmonary system through blood; 20% of patients initially present with evidence of lung metastases on computed tomography. […] Treatment of metastases relies on chemotherapy.

• #8 Osteosarcoma: A Multidisciplinary Approach to Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0315/p1123.html

  The treatment of osteosarcoma requires a multidisciplinary approach involving the family physician, orthopedic oncologist, medical oncologist, radiologist and pathologist. […] Before 1970, osteosarcomas were treated with amputation. Survival was poor: 80 percent of patients died from metastatic disease. With the development of induction and adjuvant chemotherapy protocols, advances in surgical techniques and improvements in radiologic staging studies, 90 to 95 percent of patients with osteosarcoma can now be treated with limb-sparing resection and reconstruction. Long-term survival and cure rates have increased to between 60 and 80 percent in patients with localized disease. […] Most osteosarcomas are classified as conventional, high-grade tumors. […] Over the past three decades, effective induction (neoadjuvant/preoperative) and adjuvant (postoperative) chemotherapy protocols have improved the ability to perform safe limb-sparing resections, and disease-free and overall survival rates have risen. Today, 90 to 95 percent of patients with osteosarcoma can be treated with limb-sparing surgery, and 60 to 80 percent of patients with localized disease are long-term survivors.

• #9 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  The following are treatment options for osteosarcoma. Your healthcare team will suggest treatments based on your needs and work with you to make a treatment plan. […] When deciding which treatments to offer for osteosarcoma, your healthcare team will consider: where the tumour is found, the stage of the cancer, your lifestyle and activities, your overall health. […] Chemotherapy is given for high-grade osteosarcoma. […] Chemotherapy is given before surgery to shrink the bone tumour and to treat any cancer cells that may have started to spread in the body. It is also given after surgery. If the bone tumour does not respond to the chemotherapy given before surgery, your healthcare team may use a different drug combination after surgery. […] The most common chemotherapy drug combinations used to treat osteosarcoma are: cisplatin and doxorubicin (Adriamycin), high-dose methotrexate, cisplatin and doxorubicin, ifosfamide (Ifex), cisplatin and epirubicin (Pharmorubicin), cisplatin, doxorubicin, ifosfamide and high-dose methotrexate.

• #10 Osteosarcoma and UPS of Bone Treatment – NCI

  https://www.cancer.gov/types/bone/patient/osteosarcoma-treatment-pdq

  Osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone are diseases in which cancer cells form in bone. […] Osteosarcoma and UPS are treated the same way. […] Treatment options for osteosarcoma and UPS depend on: where the tumor is in the body and if it has spread, the size of the tumor, the grade of the cancer, whether the bones are still growing, your child’s age and overall health, your child’s and family’s goals, such as being able to participate in sports, or concerns about physical appearance, whether the cancer is newly diagnosed or has recurred after treatment. […] There are different types of treatment for children with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS). […] Children with osteosarcoma or UPS should have their treatment planned by a team of health care providers who are experts in treating cancer in children.

• #11 Osteosarcoma and UPS of Bone Treatment – NCI

  https://www.cancer.gov/types/bone/patient/osteosarcoma-treatment-pdq

  Osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone are diseases in which cancer cells form in bone. […] Osteosarcoma and UPS are treated the same way. […] Treatment options for osteosarcoma and UPS depend on: where the tumor is in the body and if it has spread, the size of the tumor, the grade of the cancer, whether the bones are still growing, your child’s age and overall health, your child’s and family’s goals, such as being able to participate in sports, or concerns about physical appearance, whether the cancer is newly diagnosed or has recurred after treatment. […] There are different types of treatment for children with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS). […] Children with osteosarcoma or UPS should have their treatment planned by a team of health care providers who are experts in treating cancer in children.

• #12 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #13 Bone cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-cancer/diagnosis-treatment/drc-20350221

  Bone cancer treatments include surgery, radiation and chemotherapy. Which treatments are best for your bone cancer will depend on several factors. These factors include the type, location and stage of the bone cancer. Your healthcare team also considers your overall health and your preferences. […] The goal of surgery for bone cancer is to remove all of the cancer. The surgeon may remove the bone cancer and some of the healthy tissue around it. Then the surgeon repairs the bone. This might involve using a piece of bone from another part of your body. Sometimes the bone is repaired with metal or plastic material. […] Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form. […] Chemotherapy is often used after surgery for some types of bone cancers. It can kill any cancer cells that remain and lower the risk that the cancer will come back. Sometimes chemotherapy is given before surgery to shrink a bone cancer and make it easier to remove.

• #14 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #15 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  The following are treatment options for osteosarcoma. Your healthcare team will suggest treatments based on your needs and work with you to make a treatment plan. […] When deciding which treatments to offer for osteosarcoma, your healthcare team will consider: where the tumour is found, the stage of the cancer, your lifestyle and activities, your overall health. […] Chemotherapy is given for high-grade osteosarcoma. […] Chemotherapy is given before surgery to shrink the bone tumour and to treat any cancer cells that may have started to spread in the body. It is also given after surgery. If the bone tumour does not respond to the chemotherapy given before surgery, your healthcare team may use a different drug combination after surgery. […] The most common chemotherapy drug combinations used to treat osteosarcoma are: cisplatin and doxorubicin (Adriamycin), high-dose methotrexate, cisplatin and doxorubicin, ifosfamide (Ifex), cisplatin and epirubicin (Pharmorubicin), cisplatin, doxorubicin, ifosfamide and high-dose methotrexate.

• #16 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The main improvement in the treatment of localized osteosarcoma over the past 30 years has been the advent of chemotherapy. […] Neoadjuvant chemotherapy has the potential advantage of delivering widespread systemic treatment quickly and reducing the size of the primary cancer in order to increase the number of patients eligible for limb-sparing surgical treatment. […] Since the 1980s, the treatment of osteosarcoma has been further improved with the addition of neoadjuvant chemotherapy to conventional surgery and adjuvant chemotherapy. […] Certain chemotherapy agents are more effective in treating osteosarcoma than others. […] Radiation therapy has a limited role in the treatment of localized osteosarcoma. […] The most important factors in long-term outcomes of patients with localized osteosarcoma are the degree of anti-cancer response to neoadjuvant chemotherapy and whether or not the cancer could be completely removed with surgery.

• #17 Osteosarcoma: a review of current and future therapeutic approaches | BioMedical Engineering OnLine | Full Text

  https://biomedical-engineering-online.biomedcentral.com/articles/10.1186/s12938-021-00860-0

  In recent years, ablation has been gradually applied to limb salvage surgery for OS and has achieved good clinical effects. […] Chemotherapy drugs for OS have been updated since the 1970s. […] The significance of neoadjuvant chemotherapy is that it allows early systemic treatment to eliminate potential micrometastases; allows evaluation of preoperative chemotherapy based on tumor necrosis rate to guide postoperative chemotherapy; reduces tumor edema bands; increases the limb salvage rates; and reduces the recurrence rates. […] The concept of neoadjuvant chemotherapy has become a milestone in the history of OS treatment, and this concept continues to be used. […] For patients who cannot be surgically resected or in whom tumors remain on the resection margin, as well as for patients with OS in whom the tumors respond poorly to chemotherapy, local radiotherapy has been found to create a certain impact.

• #18 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #19 Osteosarcoma Treatment (PDQ®): Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.osteosarcoma-treatment-pdq%C2%AE-treatment-patient-information-nci.ncicdr0000062949

  Osteosarcoma is the most common type of bone cancer. […] Treatment options for osteosarcoma and UPS depend on the following: Where the tumor is in the body and if it has spread. […] Five types of standard treatment are used: Surgery, Chemotherapy, Radiation therapy, Samarium, Targeted therapy. […] Surgery to remove the entire tumor will be done when possible. Chemotherapy may be given before surgery to make the tumor smaller. […] After the doctor removes all the cancer that can be seen at the time of the surgery, patients are given chemotherapy to kill any cancer cells that are left in the area where the tumor was removed or that have spread to other parts of the body. […] Treatment of newly diagnosed localized osteosarcoma and UPS of bone may include the following: Surgery to remove the primary tumor.

• #20 Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000603/

  Osteosarcoma is the most common primary malignant bone tumor in children and young adults. The standard-of-care curative treatment for osteosarcoma utilizes doxorubicin, cisplatin, and high-dose methotrexate, a standard that has not changed in more than 40 years. […] Current treatment strategies for osteosarcoma are neoadjuvant chemotherapy with cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate with leucovorin rescue, followed by surgical resection and adjuvant chemotherapy. […] The current treatment regimen for osteosarcoma involves the use of cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate. High-dose methotrexate has demonstrated significant toxicity in the liver, kidney, and brain, and novel therapies that are more specifically targeted to osteosarcoma are needed.

• #21 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  The following are treatment options for osteosarcoma. Your healthcare team will suggest treatments based on your needs and work with you to make a treatment plan. […] When deciding which treatments to offer for osteosarcoma, your healthcare team will consider: where the tumour is found, the stage of the cancer, your lifestyle and activities, your overall health. […] Chemotherapy is given for high-grade osteosarcoma. […] Chemotherapy is given before surgery to shrink the bone tumour and to treat any cancer cells that may have started to spread in the body. It is also given after surgery. If the bone tumour does not respond to the chemotherapy given before surgery, your healthcare team may use a different drug combination after surgery. […] The most common chemotherapy drug combinations used to treat osteosarcoma are: cisplatin and doxorubicin (Adriamycin), high-dose methotrexate, cisplatin and doxorubicin, ifosfamide (Ifex), cisplatin and epirubicin (Pharmorubicin), cisplatin, doxorubicin, ifosfamide and high-dose methotrexate.

• #22 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  The following are treatment options for osteosarcoma. Your healthcare team will suggest treatments based on your needs and work with you to make a treatment plan. […] When deciding which treatments to offer for osteosarcoma, your healthcare team will consider: where the tumour is found, the stage of the cancer, your lifestyle and activities, your overall health. […] Chemotherapy is given for high-grade osteosarcoma. […] Chemotherapy is given before surgery to shrink the bone tumour and to treat any cancer cells that may have started to spread in the body. It is also given after surgery. If the bone tumour does not respond to the chemotherapy given before surgery, your healthcare team may use a different drug combination after surgery. […] The most common chemotherapy drug combinations used to treat osteosarcoma are: cisplatin and doxorubicin (Adriamycin), high-dose methotrexate, cisplatin and doxorubicin, ifosfamide (Ifex), cisplatin and epirubicin (Pharmorubicin), cisplatin, doxorubicin, ifosfamide and high-dose methotrexate.

• #23 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  The treatment of osteosarcoma also depends on the histological grade, as follows: Low-grade osteosarcoma can be treated successfully by wide surgical resection alone, regardless of site of origin. […] Patients with undifferentiated pleomorphic sarcoma (UPS) of bone are treated according to osteosarcoma treatment protocols. A sarcoma-specific survival rate of 70.7% has been reported using primarily cisplatin- and doxorubicin-based regimens. […] Treatment options for patients with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS) of bone with metastatic disease at diagnosis include chemotherapy. […] The chemotherapeutic agents used include high-dose methotrexate, doxorubicin, cisplatin, high-dose ifosfamide, etoposide, and, in some reports, carboplatin or cyclophosphamide. […] The treatment options for UPS of bone with metastasis at initial presentation are the same as the treatment for osteosarcoma with metastasis.

• #24 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #25 Chemotherapy and radiation therapy in the management of osteosarcoma – UpToDate

  https://www.uptodate.com/contents/chemotherapy-and-radiation-therapy-in-the-management-of-osteosarcoma

  Chemotherapy is a standard component of most osteosarcoma treatment, both in children and in adults. The choice of regimen and the optimal timing (ie, preoperative versus postoperative) are controversial; however, many centers preferentially utilize preoperative chemotherapy, particularly if a limb-sparing procedure is being contemplated for an extremity osteosarcoma. […] This topic review will cover the use of adjuvant and neoadjuvant chemotherapy and radiation therapy (RT) in the management of osteosarcoma. […] The choice of chemotherapy is best determined by the availability of clinical trials and, otherwise, is decided on a patient-by-patient basis, balancing the risks and benefits of chemotherapy for this high-risk diagnosis.

• #26 Innovative approaches for treatment of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8899335/

  Currently, there are three major therapeutic options are available for patients of OS: surgery, chemotherapy, and radiation therapy. […] The main aim of surgical amputation and limb-salvage in OS therapy is a complete tumor removal with a wide-ranging margin of non-cancerous normal tissue in order to avoid local reoccurrence, and improve overall survival. […] Chemotherapy has been the most common treatment for OS patients since the 1970s. […] Despite its efficacy, HDMTX has serious life-threatening side effects including renal failure, mucositis, hepatotoxicity, pulmonary toxicity, and neurotoxicity. […] Despite its good effects on patients survival, like many cytotoxic drugs, DOX also has serious effects for patients such as cardiomyopathy, symptomatic cardiac toxicity, transient electrocardiographic abnormalities, alopecia, and myelosuppression.

• #27 Innovative approaches for treatment of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8899335/

  However, the drug also has extreme side effects such as acute and chronic renal failure, peripheral neuropathy, ototoxicity, hypomagnesemia, gastrointestinal disorders, and hemorrhage. […] IFO also has dramatic side effects such as hemorrhagic cystitis, acute kidney injury, Fanconis syndrome, interstitial nephritis, glomerular disease, and encephalopathy. […] There is an urgent need for more effective and less toxic treatment for OS patients. […] This review has discussed the current treatment for OS and possible ways to develop novel therapeutic agents for the disease with the aim of less toxic and more effective treatment.

• #28 Innovative approaches for treatment of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8899335/

  However, the drug also has extreme side effects such as acute and chronic renal failure, peripheral neuropathy, ototoxicity, hypomagnesemia, gastrointestinal disorders, and hemorrhage. […] IFO also has dramatic side effects such as hemorrhagic cystitis, acute kidney injury, Fanconis syndrome, interstitial nephritis, glomerular disease, and encephalopathy. […] There is an urgent need for more effective and less toxic treatment for OS patients. […] This review has discussed the current treatment for OS and possible ways to develop novel therapeutic agents for the disease with the aim of less toxic and more effective treatment.

• #29 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma treatment most often involves surgery and chemotherapy. Rarely, radiation therapy also might be an option if the cancer can’t be treated with surgery. […] The goal of surgery is to remove all the cancer cells. In planning the surgery, the healthcare team keeps in mind how the surgery will affect your or your child’s daily life. The extent of surgery for osteosarcoma depends on several factors, such as the size of the cancer and where it is. […] Operations used to treat osteosarcoma include: Surgery to remove the cancer only, also called limb-sparing surgery. Most osteosarcoma operations can be done in a way that removes all the cancer and spares the arm or leg. […] If a section of bone is removed, the surgeon will rebuild the bone. How the bone is rebuilt depends on the situation. Options include metal implants or bone grafts.

• #30 Osteosarcoma Treatment & Management: Approach Considerations, Medical Therapy, Biopsy

  https://emedicine.medscape.com/article/1256857-treatment

  Before the use of chemotherapy (which began in the 1970s), osteosarcoma was treated primarily with surgical resection (usually amputation). […] Therefore, the use of adjuvant (postoperative) systemic chemotherapy is critical for the treatment of patients with osteosarcoma. […] The orthopedic surgeon is of paramount importance in the care of patients with osteosarcoma. […] Moreover, because osteosarcomas are not particularly responsive to radiotherapy, surgery is the only option for definitive tumor removal (local control). […] The two main procedures performed by orthopedic surgeons in patients with osteosarcoma are biopsy and wide resection. […] Because osteosarcoma is a deadly form of cancer, no absolute contraindications for treatment exist. […] The genetic roots of cancer are irrefutable, and gene-focused basic science research holds tremendous promise for risk stratification, as well as for effective and innovative treatments.

• #31 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  Surgery is used to treat osteosarcoma tumours after chemotherapy. […] The main goal of surgery is to remove the whole tumour along with a margin of normal tissue around it. […] The following types of surgery may be offered for osteosarcoma. […] Wide resection removes the bone tumour and a wide margin of normal bone and tissue around the tumour. […] Limb-sparing surgery removes the tumour without removing (amputating) the whole arm or leg (the limb). […] Amputation removes all or part of the arm or leg with the tumour. […] Reconstructive surgery is done at the same time as surgery to remove the tumour. […] External beam radiation therapy may be used to treat osteosarcoma after surgery if the tumour wasn’t completely removed. […] Radiation therapy is also used to treat pain and control the symptoms of osteosarcoma that has metastasized or come back (recurred).

• #32 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma treatment most often involves surgery and chemotherapy. Rarely, radiation therapy also might be an option if the cancer can’t be treated with surgery. […] The goal of surgery is to remove all the cancer cells. In planning the surgery, the healthcare team keeps in mind how the surgery will affect your or your child’s daily life. The extent of surgery for osteosarcoma depends on several factors, such as the size of the cancer and where it is. […] Operations used to treat osteosarcoma include: Surgery to remove the cancer only, also called limb-sparing surgery. Most osteosarcoma operations can be done in a way that removes all the cancer and spares the arm or leg. […] If a section of bone is removed, the surgeon will rebuild the bone. How the bone is rebuilt depends on the situation. Options include metal implants or bone grafts.

• #33 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma treatment most often involves surgery and chemotherapy. Rarely, radiation therapy also might be an option if the cancer can’t be treated with surgery. […] The goal of surgery is to remove all the cancer cells. In planning the surgery, the healthcare team keeps in mind how the surgery will affect your or your child’s daily life. The extent of surgery for osteosarcoma depends on several factors, such as the size of the cancer and where it is. […] Operations used to treat osteosarcoma include: Surgery to remove the cancer only, also called limb-sparing surgery. Most osteosarcoma operations can be done in a way that removes all the cancer and spares the arm or leg. […] If a section of bone is removed, the surgeon will rebuild the bone. How the bone is rebuilt depends on the situation. Options include metal implants or bone grafts.

• #34 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  Osteosarcoma, the most common bone cancer, most often occurs in children and adolescents. […] Use of neoadjuvant and adjuvant chemotherapy, in combination with surgery, has improved survival rates to nearly 80% for patients with localized disease, and 90% to 95% of patients do not require limb amputation. […] The current mainstay of treatment for osteosarcoma is neoadjuvant chemotherapy, followed by surgical resection and adjuvant chemotherapy. […] The current five-year survival rate is more than 70% in persons with nonmetastatic disease. […] Neoadjuvant chemotherapy regimens aim to cause tumor necrosis and decrease primary tumor size, as well as the number and size of pulmonary metastases. […] Surgical excision is the definitive treatment for osteosarcoma. […] Currently, 90% to 95% of patients with extremity osteosarcoma avoid amputation with successful limb-sparing resections. […] Osteosarcoma most often metastasizes to the pulmonary system through blood; 20% of patients initially present with evidence of lung metastases on computed tomography. […] Treatment of metastases relies on chemotherapy.

• #35 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Osteosarcoma treatment most often involves surgery and chemotherapy. Rarely, radiation therapy also might be an option if the cancer can’t be treated with surgery. […] The goal of surgery is to remove all the cancer cells. In planning the surgery, the healthcare team keeps in mind how the surgery will affect your or your child’s daily life. The extent of surgery for osteosarcoma depends on several factors, such as the size of the cancer and where it is. […] Operations used to treat osteosarcoma include: Surgery to remove the cancer only, also called limb-sparing surgery. Most osteosarcoma operations can be done in a way that removes all the cancer and spares the arm or leg. […] If a section of bone is removed, the surgeon will rebuild the bone. How the bone is rebuilt depends on the situation. Options include metal implants or bone grafts.

• #36 Osteosarcoma Treatment & Management: Approach Considerations, Medical Therapy, Biopsy

  https://emedicine.medscape.com/article/1256857-treatment

  Wide resection is the goal for patients in whom primary tumor resection is contemplated. […] When limb-salvage reconstruction is possible, the following options exist, which must be chosen on the basis of individual considerations: Autologous bone graft, Allograft, Prosthesis, Rotationplasty. […] After tumor resection, vessels are usually repaired in an end-to-end fashion to optimize patency. […] Metastatic lung nodules can be cured by means of complete surgical resection (most often wedge resection). […] For an osteosarcoma that recurs as one or more lung lesions only more than 1 year after the patient is off therapy, surgical resection alone can be curative; the likelihood of metastases to other sites is low. […] Hearing loss is an adverse effect of cisplatin. […] Restrictions on activity vary with the location of the tumor and the type of surgical procedure required for treatment.

• #37 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Surgery to remove the affected arm or leg, also called amputation. Rarely a surgeon might remove the affected leg or arm to get all the cancer. […] After surgery, chemotherapy treatments might be used to kill any cancer cells that might remain. […] For osteosarcoma that returns after surgery or spreads to other areas of the body, chemotherapy might help relieve pain and slow the growth of the cancer. […] Radiation is not often used to treat osteosarcoma. Radiation therapy might be suggested instead of surgery if surgery can’t remove all the cancer. […] Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known.

• #38

  https://www.americanoncology.com/cancer-we-treat/treatment/osteosarcoma

  The treatment options for osteosarcoma include: […] Surgery is an important treatment intervention for the management of osteosarcoma and can alone treat bone cancer that is limited to the bone. […] The surgery aims to remove all the cancer of the bone, as partial removal may result in recurrence. […] Oncosurgeons performed wedge resection to minimize the risk of recurrence. […] Limb salvage surgery aims to remove the complete tumor from the limbs and keep the anatomical and functional capacity of the limbs intact. […] Amputation may be performed if limb salvage surgery is not possible in the patient because the tumor is very large and has spread to the blood vessels and nerves. […] Chemotherapy is used when cancer spreads to other body parts. […] Chemotherapy is generally combined with surgery or radiation therapy to improve outcomes.

• #39 6 Innovative Childhood Osteosarcoma Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/childhood-osteosarcoma/childhood-osteosarcoma-treatment.html

  Like all surgeries, osteosarcoma surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure. MD Anderson surgeons are among the most skilled and recognized in the world. They among the few surgeons in the world who specialize in pediatric sarcoma treatment, and they use the least-invasive and most advanced methods. […] Osteosarcoma chemotherapy treatment is usually given before (neoadjuvant chemotherapy) and after surgery (adjuvant chemotherapy). […] Childrens Cancer Hospital offers the most up-to-date and advanced chemotherapy options. […] Radiation therapy (also called radiotherapy) uses high-energy beams to destroy cancer cells. Osteosarcoma cells do not respond well to radiation, so it is not a main part of treatment for most cases. It may be used if the tumor cannot be completely removed by surgery or to help control symptoms.

• #40 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Osteosarcoma can be diagnosed by core needle biopsy or open surgical biopsy. It is preferable that the biopsy be performed by a surgeon skilled in the techniques of limb sparing (removal of the malignant bone tumor without amputation and replacement of bones or joints with allografts or prosthetic devices). In these cases, the original biopsy incision placement is crucial. Inappropriate alignment of the biopsy or inadvertent contamination of soft tissues can render subsequent limb-preserving reconstructive surgery impossible. […] Successful treatment generally requires the combination of effective systemic chemotherapy and complete resection of all clinically detectable disease. […] Randomized clinical trials have established that both neoadjuvant and adjuvant chemotherapy are effective in preventing relapse in patients with clinically nonmetastatic tumors.

• #41 Osteosarcoma Treatment & Management: Approach Considerations, Medical Therapy, Biopsy

  https://emedicine.medscape.com/article/1256857-treatment

  Before the use of chemotherapy (which began in the 1970s), osteosarcoma was treated primarily with surgical resection (usually amputation). […] Therefore, the use of adjuvant (postoperative) systemic chemotherapy is critical for the treatment of patients with osteosarcoma. […] The orthopedic surgeon is of paramount importance in the care of patients with osteosarcoma. […] Moreover, because osteosarcomas are not particularly responsive to radiotherapy, surgery is the only option for definitive tumor removal (local control). […] The two main procedures performed by orthopedic surgeons in patients with osteosarcoma are biopsy and wide resection. […] Because osteosarcoma is a deadly form of cancer, no absolute contraindications for treatment exist. […] The genetic roots of cancer are irrefutable, and gene-focused basic science research holds tremendous promise for risk stratification, as well as for effective and innovative treatments.

• #42 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  Surgery is used to treat osteosarcoma tumours after chemotherapy. […] The main goal of surgery is to remove the whole tumour along with a margin of normal tissue around it. […] The following types of surgery may be offered for osteosarcoma. […] Wide resection removes the bone tumour and a wide margin of normal bone and tissue around the tumour. […] Limb-sparing surgery removes the tumour without removing (amputating) the whole arm or leg (the limb). […] Amputation removes all or part of the arm or leg with the tumour. […] Reconstructive surgery is done at the same time as surgery to remove the tumour. […] External beam radiation therapy may be used to treat osteosarcoma after surgery if the tumour wasn’t completely removed. […] Radiation therapy is also used to treat pain and control the symptoms of osteosarcoma that has metastasized or come back (recurred).

• #43 Osteosarcoma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/osteosarcoma/diagnosis-treatment/drc-20351053

  Surgery to remove the affected arm or leg, also called amputation. Rarely a surgeon might remove the affected leg or arm to get all the cancer. […] After surgery, chemotherapy treatments might be used to kill any cancer cells that might remain. […] For osteosarcoma that returns after surgery or spreads to other areas of the body, chemotherapy might help relieve pain and slow the growth of the cancer. […] Radiation is not often used to treat osteosarcoma. Radiation therapy might be suggested instead of surgery if surgery can’t remove all the cancer. […] Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known.

• #44 Treatments for osteosarcoma | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/bone/treatment/osteosarcoma

  Surgery is used to treat osteosarcoma tumours after chemotherapy. […] The main goal of surgery is to remove the whole tumour along with a margin of normal tissue around it. […] The following types of surgery may be offered for osteosarcoma. […] Wide resection removes the bone tumour and a wide margin of normal bone and tissue around the tumour. […] Limb-sparing surgery removes the tumour without removing (amputating) the whole arm or leg (the limb). […] Amputation removes all or part of the arm or leg with the tumour. […] Reconstructive surgery is done at the same time as surgery to remove the tumour. […] External beam radiation therapy may be used to treat osteosarcoma after surgery if the tumour wasn’t completely removed. […] Radiation therapy is also used to treat pain and control the symptoms of osteosarcoma that has metastasized or come back (recurred).

• #45 6 Innovative Childhood Osteosarcoma Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/childhood-osteosarcoma/childhood-osteosarcoma-treatment.html

  If radiation is needed, new radiation therapy techniques allow Childrens Cancer Hospital doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. […] Childrens Cancer Hospital provides leading-edge radiation treatments, including 3D-conformal radiation therapy and intensity-modulated radiotherapy (IMRT), which are tailored to the specific shape of the tumor. […] Childrens Cancer Hospital is leading into the future of cancer treatment by developing innovative targeted therapies. These agents are specially designed to treat each cancers specific genetic/molecular profile to help the body fight the disease. […] Since osteosarcoma usually requires multiple treatments, a comprehensive, personalized team approach is crucial. At the Childrens Cancer Hospital, your child is the focus of a multidisciplinary group of specialized physicians, including surgeons, oncologists, radiation oncologists and pathologists, who are with your child throughout treatment.

• #46 Proton Therapy for Bone Cancer | Bone Tumors | Osteosarcoma

  https://www.floridaproton.org/cancers-treated/bone-cancer

  The University of Florida Health Proton Therapy Institute is committed to advancing the treatment of bone tumors including osteosarcoma with proton therapy. […] Treatment of osteosarcoma requires a careful and precise method of treatment to reduce the risk of side effects and contribute to a successful outcome for both adult patients and pediatric cancer patients. […] In cases of osteosarcoma where complete surgical removal of the tumor is not possible, high-dose radiation is the treatment of choice and the best results are observed following proton therapy. […] Unlike other types of radiation, proton therapy targets osteosarcoma with a precise beam of protons, delivering a highly effective dose to the bone cancer while sparing surrounding healthy tissues. […] In cases where complete removal of bone sarcoma is not possible, proton therapy may be used to treat tumors without exposing surrounding tissues to high doses of radiation.

• #47 Bone Cancer (Osteosarcoma) Treatment Program | Massachusetts General Hospital

  https://www.massgeneral.org/cancer-center/treatments-and-services/sarcoma/bone-cancer

  Today, 90 to 95 percent of our bone cancer patients can be safely treated with limb-sparing techniques. […] Our radiation oncologists offer a range of therapies designed to shrink or destroy tumors while protecting normal tissue. […] Advanced technologies include: Intraoperative radiation therapy (IORT), a novel technique to deliver additional radiation during surgery to areas where the proximity of critical normal tissue prevents surgeons from removing as much tissue around the tumor as they would like. […] Proton beam therapy, a highly focused form of radiation that delivers precise radiation to the tumor while helping to spare surrounding tissue. […] Research conducted at Massachusetts General Hospital Cancer Center and other cancer centers is leading to better understanding of the genetic basis of soft tissue sarcomas.

• #48 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

  Osteosarcoma that has spread from the initially affected bone to one or more sites in the body, distant from the site of origin, is called metastatic. The most common site to which osteosarcoma spreads, or metastasizes, is the lungs. Metastatic osteosarcoma is typically difficult to control, though patients with lung metastases have a better prognosis than patients with distant metastases. Historically, less than 20% of patients with metastatic osteosarcoma survived without recurrence of their cancer. However, survival has improved with the development of more effective chemotherapy. […] The following is a general overview of treatment for metastatic osteosarcoma. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patients chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.

• #49 Osteosarcoma and UPS of Bone Treatment – NCI

  https://www.cancer.gov/types/bone/patient/osteosarcoma-treatment-pdq

  The following types of treatment are used: Surgery, Chemotherapy, Radiation therapy, Samarium. […] Treatment of newly diagnosed localized osteosarcoma and UPS of bone may include: surgery to remove the tumor, chemotherapy before or after surgery to remove the tumor, radiation therapy if surgery cannot be done or if the tumor was not completely removed by surgery. […] Treatment of newly diagnosed osteosarcoma and UPS that has spread to the lung may include chemotherapy followed by surgery to remove the primary cancer and more chemotherapy. […] Treatment of newly diagnosed osteosarcoma and UPS that has spread to a distant bone or to both the lung and a distant bone may include: Chemotherapy followed by surgery to remove the primary cancer. […] Treatment depends on where the cancer recurred and whether it has recurred more than once.

• #50 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

  The main improvement in the treatment of osteosarcoma over the past 30 years has been the development of chemotherapy. Historically, chemotherapy was administered as an adjuvant, or after surgery. Clinical trials have shown that treatment of osteosarcoma with adjuvant chemotherapy improves the patients chance of survival and decreases the risk of cancer recurrence compared to local therapy alone. More recently, neoadjuvant chemotherapy has been developed. This is the administration of chemotherapy before surgery in order to shrink the cancer. […] Chemotherapy using multiple drugs, called combined chemotherapy, followed by surgery to remove as much of both the primary and metastatic cancer as possible, may be the most promising treatment for metastatic osteosarcoma. […] The third treatment evaluated was neoadjuvant Paraplatin chemotherapy followed by surgery, when feasible, and then 40 weeks of adjuvant chemotherapy. This combination appears to be less effective than the Ifex-based treatment.

• #51 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Control of osteosarcoma after recurrence depends on complete surgical resection of all sites of clinically detectable metastatic disease. […] The role of systemic chemotherapy for the treatment of patients with recurrent osteosarcoma is not well defined. […] The following chemotherapy and targeted therapy agents have been studied to treat recurrent osteosarcoma and UPS of bone: Ifosfamide alone with mesna uroprotection, or in combination with etoposide, has been active in as many as one-third of patients with recurrent osteosarcoma who have not previously received this drug. […] High-dose samarium Sm 153-ethylenediamine tetramethylene phosphonic acid (153Sm-EDTMP) coupled with peripheral blood stem cell support may provide significant pain palliation in patients with bone metastases. […] If complete surgical resection is not feasible or if surgical margins are inadequate, radiation therapy may improve the local control rate. […] External-beam radiation therapy can provide local control of recurrent unresectable disease, symptomatic, and/or metastatic disease.

• #52 Osteosarcoma Treatment & Management: Approach Considerations, Medical Therapy, Biopsy

  https://emedicine.medscape.com/article/1256857-treatment

  Wide resection is the goal for patients in whom primary tumor resection is contemplated. […] When limb-salvage reconstruction is possible, the following options exist, which must be chosen on the basis of individual considerations: Autologous bone graft, Allograft, Prosthesis, Rotationplasty. […] After tumor resection, vessels are usually repaired in an end-to-end fashion to optimize patency. […] Metastatic lung nodules can be cured by means of complete surgical resection (most often wedge resection). […] For an osteosarcoma that recurs as one or more lung lesions only more than 1 year after the patient is off therapy, surgical resection alone can be curative; the likelihood of metastases to other sites is low. […] Hearing loss is an adverse effect of cisplatin. […] Restrictions on activity vary with the location of the tumor and the type of surgical procedure required for treatment.

• #53 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

  Osteosarcoma that has spread from the initially affected bone to one or more sites in the body, distant from the site of origin, is called metastatic. The most common site to which osteosarcoma spreads, or metastasizes, is the lungs. Metastatic osteosarcoma is typically difficult to control, though patients with lung metastases have a better prognosis than patients with distant metastases. Historically, less than 20% of patients with metastatic osteosarcoma survived without recurrence of their cancer. However, survival has improved with the development of more effective chemotherapy. […] The following is a general overview of treatment for metastatic osteosarcoma. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patients chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.

• #54 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

  Osteosarcoma that has spread from the initially affected bone to one or more sites in the body, distant from the site of origin, is called metastatic. The most common site to which osteosarcoma spreads, or metastasizes, is the lungs. Metastatic osteosarcoma is typically difficult to control, though patients with lung metastases have a better prognosis than patients with distant metastases. Historically, less than 20% of patients with metastatic osteosarcoma survived without recurrence of their cancer. However, survival has improved with the development of more effective chemotherapy. […] The following is a general overview of treatment for metastatic osteosarcoma. Treatment may consist of surgery, radiation, chemotherapy, biological therapy, or a combination of these treatment techniques. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patients chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.

• #55 Osteosarcoma | OS Therapies

  https://ostherapies.com/learn/osteosarcoma/

  Osteosarcoma is a rare but aggressive form of bone cancer that is most common in children, teens and young adults aged 10 to 30. […] Additionally, osteosarcoma is known to metastasize quickly and has a tendency to spread to the lungs, a factor that has significantly complicated treatment and lowered survival rates. […] Over the past 40 years, advancements in survival rates for osteosarcoma have been minimal. Despite the use of aggressive multimodal therapies, including surgery, chemotherapy, and sometimes radiation, the five-year survival rate has remained stagnant at approximately 60-70% for localized disease. For metastatic osteosarcoma, the survival rate drops dramatically to 15-30%, underscoring the urgent need for innovation. […] Currently, treatment involves tumor resection surgery combined with chemotherapy regimens like methotrexate, doxorubicin, and cisplatin. However, these treatments often come with severe side effects, and their effectiveness is limited, especially for recurrent or metastatic cases.

• #56 Innovative approaches for treatment of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8899335/

  However, the drug also has extreme side effects such as acute and chronic renal failure, peripheral neuropathy, ototoxicity, hypomagnesemia, gastrointestinal disorders, and hemorrhage. […] IFO also has dramatic side effects such as hemorrhagic cystitis, acute kidney injury, Fanconis syndrome, interstitial nephritis, glomerular disease, and encephalopathy. […] There is an urgent need for more effective and less toxic treatment for OS patients. […] This review has discussed the current treatment for OS and possible ways to develop novel therapeutic agents for the disease with the aim of less toxic and more effective treatment.

• #57 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #58 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #59 Bone Cancer Treatment & Pharmacologic Management

  https://www.cancertherapyadvisor.com/ddi/bone-cancer-treatment-pharmacologic-management/

  The outcomes of chemotherapy in patients with metastatic disease at presentation are significantly poorer than those with nonmetastatic, high-grade, localized osteosarcoma. For the management of resectable metastatic disease at presentation, chemotherapy with cisplatin/doxorubicin and MAP, metastasectomy, and stereotactic radiation therapy are suggested treatment options. Alternatively, ablation may be considered if lung metastasectomy is not possible. Chemotherapy plus radiotherapy is recommended for unresectable metastatic disease, followed by reassessment of the primary site for local control. Clinicians should consider testing for tumor mutational burden and mismatch repair/microsatellite instability to inform treatment options. […] Chemotherapy and/or excision, if possible, are recommended for relapsed or refractory osteosarcoma. If the patient responds to treatment, continue surveillance. Clinical trial participation, radiotherapy, or best supportive care may also be considered if there is relapse or progression. Second-line drug therapy options for relapsed, refractory, or metastatic osteosarcoma include the following: Cabozantinib, Cyclophosphamide and topotecan, Docetaxel and gemcitabine, Gemcitabine, High-dose ifosfamide and etoposide (preferred), Regorafenib (preferred), Sorafenib (preferred), Sorafenib and everolimus.

• #60 Pathogenesis and Current Treatment of Osteosarcoma: Perspectives for Future Therapies

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8000603/

  The treatment landscape for osteosarcoma in the curative setting has not evolved since the introduction of high-dose methotrexate to the standard cytotoxic chemotherapies. The palliative setting is clinical trial-rich, with over 500 clinical trials targeting novel pathways of interest in osteosarcoma. […] RANK signaling has been demonstrated to be important in osteosarcoma development, growth, and motility, and the overexpression of RANK and RANKL has been correlated with poorer outcomes. Osteoblast-secreted RANKL has therefore been explored as a possible target for antibody-based therapies, as inhibiting RANK signaling on osteoclasts could decrease osteosarcoma cell migration and invasion abilities. Denosumab, an antibody to RANKL, is an anti-resorptive agent that has been used in patients with osteoporosis and is being explored in patients with refractory or relapsed osteosarcoma.

• #61 Immunotherapy in Osteosarcoma Treatment: What to Know

  https://osinst.org/immunotherapy/

  Immunotherapy is relatively new, with the first immune checkpoint inhibitor approved by the FDA in 2011. Immunotherapy drugs strengthen or train the immune system to better fight off cancer cells. Immunotherapy tends to be much better tolerated than chemotherapy, causing fewer and less-severe side effects. […] There has been little success so far in developing immunotherapy that is effective against osteosarcoma, which is why research is so important. […] Researchers are learning more about osteosarcoma and the immune system all the time, and that knowledge is being applied to the development of immunotherapies for osteosarcoma. Two especially promising areas of study are CAR T cell therapy and natural killer cell therapy. […] While immunotherapy for osteosarcoma looks promising, research, drug development, testing, and manufacturing all take time. Both Dr. Rezvani and Dr. Majzner say we are likely still years away from immunotherapy being widely available to osteosarcoma patients. […] We know novel therapies are urgently needed by patients with osteosarcoma and we feel that sense of urgency.

• #62 Treatment options | Bone cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bone-cancer/treatment/treatment-options-for-bone-cancer

  The main treatments for cancer that starts in your bone (primary bone cancer) include: surgery, chemotherapy, radiotherapy. […] Some people with osteosarcoma will have a targeted drug. […] Surgery and chemotherapy are the most common treatments for primary bone cancer. Radiotherapy is an important treatment for some bone cancers. […] Chemotherapy is part of standard treatment. Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. It works well for some types of bone cancers such as Ewing sarcoma and osteosarcoma. You usually have chemotherapy before and after surgery. […] You usually have chemotherapy before surgery to treat the cancer and any cells that may be elsewhere in the body. You then have surgery. After surgery you have more chemotherapy. […] Children and young adults between the ages of 2 and 30 might have a targeted cancer drug called mifamurtide (Mepact). You have this alongside chemotherapy after surgery if you have a high grade osteosarcoma.

• #63 Osteosarcoma – Macmillan Cancer Support | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bone-cancer/osteosarcoma

  You usually have a combination of the following treatments for osteosarcoma: Surgery is usually the main treatment. It is used to remove the area of bone affected by osteosarcoma. […] Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. For people with osteosarcoma, it is usually given before surgery. The aim is to shrink the tumour and improve the results of surgery. […] Chemotherapy after surgery also helps to destroy any remaining cancer cells (adjuvant chemotherapy). Osteosarcoma might be treated with a chemotherapy drug called ifosfamide, or different combinations of chemotherapy drugs. […] Children, teenagers and adults aged 30 or under having chemotherapy after surgery may also have a targeted therapy called mifamurtide (Mepact). Mifamurtide is a targeted therapy drug that helps the immune system to destroy cancer cells. This can help reduce the risk of osteosarcoma coming back.

• #64 Immunotherapy in Osteosarcoma Treatment: What to Know

  https://osinst.org/immunotherapy/

  Immunotherapy is relatively new, with the first immune checkpoint inhibitor approved by the FDA in 2011. Immunotherapy drugs strengthen or train the immune system to better fight off cancer cells. Immunotherapy tends to be much better tolerated than chemotherapy, causing fewer and less-severe side effects. […] There has been little success so far in developing immunotherapy that is effective against osteosarcoma, which is why research is so important. […] Researchers are learning more about osteosarcoma and the immune system all the time, and that knowledge is being applied to the development of immunotherapies for osteosarcoma. Two especially promising areas of study are CAR T cell therapy and natural killer cell therapy. […] While immunotherapy for osteosarcoma looks promising, research, drug development, testing, and manufacturing all take time. Both Dr. Rezvani and Dr. Majzner say we are likely still years away from immunotherapy being widely available to osteosarcoma patients. […] We know novel therapies are urgently needed by patients with osteosarcoma and we feel that sense of urgency.

• #65 New immunotherapy for osteosarcoma – Vaccine therapy for osteosarcoma | Booking Health

  https://bookinghealth.com/blog/diagnoses-and-treatment/diagnosis-and-treatment/697713-treatment-of-osteosarcoma-with-dendritic-cells.html

  Dendritic cells are immune cells responsible for identifying foreign and abnormal cells, including cancer cells, and presenting them to T cells for destruction. In dendritic cell osteosarcoma treatment, doctors isolate a patient’s immature dendritic cells from the blood and transform them into active dendritic cells in the laboratory. During initial stages of the maturation process, these cells are exposed to tumor antigens, proteins from the patient’s own tumor tissue, so that they can „learn” to recognize and attack osteosarcoma cells. […] This type of therapy is fundamentally different from traditional chemotherapy. Cytotoxic drugs indiscriminately kill both healthy and cancerous cells. In contrast, immunotherapy of osteosarcoma targets tumor cells with precision and minimal side effects. It works by enhancing the body’s natural immune response, making it a highly promising osteosarcoma alternative treatment, especially in cases where chemotherapy has failed or caused significant complications.

• #66 Chemotherapy and Other Drugs for Osteosarcoma | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating/chemotherapy.html

  Chemotherapy (chemo) is the use of drugs to treat cancer. The drugs are usually given into a vein and can reach and destroy cancer cells throughout the body. […] Chemo is an important part of the treatment for most people with osteosarcoma (although some patients with low-grade osteosarcoma might not need it). […] Most osteosarcomas are treated with chemo before surgery (known as neoadjuvant chemotherapy) for about 10 weeks. […] Chemo is then given again after surgery (known as adjuvant chemotherapy) for up to a year. […] Many experts recommend that the drugs be given in very high doses when possible. […] If chemo drugs are no longer helpful, other types of drugs might be an option in some situations. […] Doctors are now studying newer drugs that target specific parts of tumor cells (or nearby cells) as a way to treat osteosarcoma. […] For example, regorafenib (Stivarga), sorafenib (Nexavar), and cabozantinib (Cabometyx) are drugs that affect a tumors ability to develop new blood vessels, which it needs to grow. […] Drugs that include a radioactive element can sometimes be helpful in people with advanced osteosarcoma.

• #67 Osteosarcoma and UPS of Bone Treatment (PDQ®) – NCI

  https://www.cancer.gov/types/bone/hp/osteosarcoma-treatment-pdq

  Control of osteosarcoma after recurrence depends on complete surgical resection of all sites of clinically detectable metastatic disease. […] The role of systemic chemotherapy for the treatment of patients with recurrent osteosarcoma is not well defined. […] The following chemotherapy and targeted therapy agents have been studied to treat recurrent osteosarcoma and UPS of bone: Ifosfamide alone with mesna uroprotection, or in combination with etoposide, has been active in as many as one-third of patients with recurrent osteosarcoma who have not previously received this drug. […] High-dose samarium Sm 153-ethylenediamine tetramethylene phosphonic acid (153Sm-EDTMP) coupled with peripheral blood stem cell support may provide significant pain palliation in patients with bone metastases. […] If complete surgical resection is not feasible or if surgical margins are inadequate, radiation therapy may improve the local control rate. […] External-beam radiation therapy can provide local control of recurrent unresectable disease, symptomatic, and/or metastatic disease.

• #68 Bone Cancer Treatment & Pharmacologic Management

  https://www.cancertherapyadvisor.com/ddi/bone-cancer-treatment-pharmacologic-management/

  The outcomes of chemotherapy in patients with metastatic disease at presentation are significantly poorer than those with nonmetastatic, high-grade, localized osteosarcoma. For the management of resectable metastatic disease at presentation, chemotherapy with cisplatin/doxorubicin and MAP, metastasectomy, and stereotactic radiation therapy are suggested treatment options. Alternatively, ablation may be considered if lung metastasectomy is not possible. Chemotherapy plus radiotherapy is recommended for unresectable metastatic disease, followed by reassessment of the primary site for local control. Clinicians should consider testing for tumor mutational burden and mismatch repair/microsatellite instability to inform treatment options. […] Chemotherapy and/or excision, if possible, are recommended for relapsed or refractory osteosarcoma. If the patient responds to treatment, continue surveillance. Clinical trial participation, radiotherapy, or best supportive care may also be considered if there is relapse or progression. Second-line drug therapy options for relapsed, refractory, or metastatic osteosarcoma include the following: Cabozantinib, Cyclophosphamide and topotecan, Docetaxel and gemcitabine, Gemcitabine, High-dose ifosfamide and etoposide (preferred), Regorafenib (preferred), Sorafenib (preferred), Sorafenib and everolimus.

• #69 Treating Osteosarcoma | Osteosarcoma Treatments | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating.html

  Treatment for osteosarcoma is often effective, but it can also cause serious side effects. Its important to discuss all treatment options as well as their possible side effects with the cancer care team so you can make an informed decision. […] If time allows, getting a second opinion from another doctor experienced in treating osteosarcoma is often a good idea. This can give you more information and help you feel more confident about the treatment plan you choose. […] Today, most children and teens with cancer are treated at specialized childrens cancer centers. These centers offer the most up-to-date treatment by conducting clinical trials (studies of promising new therapies). […] Adults with cancer also typically have the option to participate in clinical trials as a way to get state-of-the art cancer treatment.

• #70 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

  As a generality, patients with metastatic osteosarcoma have the same primary surgery performed as patients with localized disease. It is important to gain local control in order to better treat metastatic disease. […] Radiation therapy has a limited role in the treatment of metastatic osteosarcoma. […] The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Future progress in the treatment of metastatic osteosarcoma will result from the continued evaluation of new treatments in clinical trials. […] High-dose chemotherapy is an intensive treatment that can kill more cancer cells than traditional chemotherapy. […] Several small pilot studies have evaluated the use of high-dose chemotherapy with autologous stem cell transplantation in patients with advanced osteosarcoma. The results of these studies suggest that this treatment may be an effective treatment for selected patients with metastatic osteosarcoma.

• #71 Metastatic Osteosarcoma | Nebraska Hematology Oncology – Cancer Care Treatment Blood Disorders Clinical Trials Lincoln Nebraska (NE)

  https://www.yourcancercare.com/types-of-cancer/bone-cancer/osteosarcoma-overview/metastatic-osteosarcoma

• #72 Treating Osteosarcoma | Osteosarcoma Treatments | American Cancer Society

  https://www.cancer.org/cancer/types/osteosarcoma/treating.html

  If you or your child has been diagnosed with osteosarcoma, the cancer care team will discuss treatment options with you. Its important to weigh the benefits of each option against the possible risks and side effects. […] Three main types of treatment are used for osteosarcoma: Surgery for Osteosarcoma, Chemotherapy and Other Drugs for Osteosarcoma, Radiation Therapy for Osteosarcoma. […] Most often, chemotherapy 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. Radiation therapy is used less often. […] A team approach is recommended when treating osteosarcoma. For children and teens, this team includes the childs pediatrician as well as childrens cancer specialists. Treatment is best done at a childrens cancer center. For adults with osteosarcoma, the treatment team typically includes the patients primary care doctor, as well as specialists at a major cancer center.

• #73 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The delivery of systemic therapy in addition to local treatment is necessary to maximize a patients chance of cure. Most patients diagnosed with localized osteosarcoma actually have micrometastases that are undetectable by current procedures. […] The multi-modality approach to treatment for osteosarcoma requires that patients be treated by a multi-disciplinary team consisting of the primary care physician, an orthopedic surgeon experienced in bone tumors, a pathologist, radiation oncologists, pediatric oncologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others. […] The ultimate goal of surgery for localized osteosarcoma is to remove the cancer without amputation. […] Even with the advent of chemotherapy as systemic treatment, surgery is still an important component of treatment for osteosarcoma.

• #74 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The delivery of systemic therapy in addition to local treatment is necessary to maximize a patients chance of cure. Most patients diagnosed with localized osteosarcoma actually have micrometastases that are undetectable by current procedures. […] The multi-modality approach to treatment for osteosarcoma requires that patients be treated by a multi-disciplinary team consisting of the primary care physician, an orthopedic surgeon experienced in bone tumors, a pathologist, radiation oncologists, pediatric oncologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others. […] The ultimate goal of surgery for localized osteosarcoma is to remove the cancer without amputation. […] Even with the advent of chemotherapy as systemic treatment, surgery is still an important component of treatment for osteosarcoma.

• #75 Osteosarcoma – Macmillan Cancer Support | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/bone-cancer/osteosarcoma

  Osteosarcoma is rare, so it is treated by a team of doctors and other healthcare professionals at a hospital with a specialist sarcoma centre. […] Your test results are discussed by a team of specialist health care professionals. If your tests show a diagnosis of bone cancer, a team of specialist doctors and other professionals called a multidisciplinary team (MDT) will meet. They will discuss the best possible treatment for you. […] After the MDT meeting, your cancer doctor or specialist nurse will explain the treatment options and possible side effects to you. They will also talk to you about things to consider when making a decision. […] The treatment you have depends on a number of things, including: the position of the cancer, the size of the cancer, if it has spread (its stage), the grade of the cancer, your general health.

• #76 Osteosarcoma Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/pediatrics/cancer-care/types/osteosarcoma/treatment

  Together, the team has achieved a very low rate of recurrence in children with osteosarcoma just 3.5 percent, versus 13 to 14 percent elsewhere. […] Your childs orthopedic surgeon tailors all treatment discussions to your childs age and understanding, and takes his or her goals and preferences to heart. […] MSK Kids treats more young people with osteosarcoma and Ewing sarcoma than any other center in the country. […] Our goal is to completely remove the tumor while maintaining the arm or leg and supporting your childs ability to move and function freely. We do not perform amputation unless all other treatment options have been exhausted first.

• #77 Recurrent Osteosarcoma – Virginia Cancer Institute

  https://www.vacancer.com/cancer/bone-cancer/osteosarcoma-overview/recurrent-osteosarcoma/

  The multi-modality approach to treatment for osteosarcoma requires that patients be treated by a multi-disciplinary team that may consist of a primary care physician, an orthopedic surgeon experienced in bone tumors, a pathologist, radiation oncologists, pediatric oncologists, rehabilitation specialists, pediatric nurse specialists, social workers, and others. An experienced team is best found in a specialty cancer center that treats many patients with osteosarcoma. Engaging a multidisciplinary team at one of these centers helps ensure that the patient receives treatment, supportive care, and rehabilitation that will achieve optimal survival and quality of life. […] A small fraction of patients with recurrent disease will have only local disease and no evidence of metastatic disease. The first line of therapy is surgical removal or amputation. If surgery is not feasible then local radiation therapy is probably the best therapy.

• #78 Osteosarcoma | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/osteosarcoma

  Depending on the size and location of the tumor and whether the tumor has spread, your child may receive one or more of several surgical treatments. Limb-salvage surgery helps preserve the limb by removing the tumor and wide margins of healthy tissue surrounding the tumor. […] Amputation may be necessary if the tumor cannot be completely removed (for example, if it involves the nerves and blood vessels) or if limb function cannot be preserved through limb-salvage surgery. […] Chemotherapy is a group of drugs that interfere with the cancer cell’s ability to grow or reproduce. Different groups of chemotherapy drugs work in varied ways to fight cancer cells and shrink tumors. […] Rehabilitation is an extremely important part of your child’s osteosarcoma care. This includes physical and occupational therapy, as well as help adapting to social situations. […] Supportive care is treatment to prevent and treat infections, side effects of treatments, and complications. The goal is to keep your child comfortable during treatment. It also is an important part of preventing short- and long-term complications of the disease and treatment.

• #79 Osteosarcoma Causes, Symptoms, and Treatment 

  https://www.upmc.com/services/orthopaedics/conditions/osteosarcoma

  Doctors treat osteosarcoma with a combination of chemotherapy and surgery. […] Doctors usually treat osteosarcoma with a combination of chemotherapy and surgery. But the specific treatment your doctor recommends will depend on several factors, such as: […] Chemotherapy is medication to treat cancer. Doctors usually give it to people in the hospital through an IV. They use it to treat osteosarcoma: […] Successful surgery for osteosarcoma means getting rid of all the cancer. To accomplish that, surgeons will need to remove some of the bone and surrounding tissue. They’ll try to save and rebuild as much of the limb as possible. […] The two types of surgery for osteosarcoma are: […] Recovery from osteosarcoma treatment for you or your child will require rehabilitation and follow-up care. You may need to use crutches, a cane, or a walker for some time. […] With physical therapy and follow-up care, most people notice continued improvement in strength and mobility for one to two years after surgery for osteosarcoma.

• #80 Osteosarcoma Causes, Symptoms, and Treatment 

  https://www.upmc.com/services/orthopaedics/conditions/osteosarcoma

  Doctors treat osteosarcoma with a combination of chemotherapy and surgery. […] Doctors usually treat osteosarcoma with a combination of chemotherapy and surgery. But the specific treatment your doctor recommends will depend on several factors, such as: […] Chemotherapy is medication to treat cancer. Doctors usually give it to people in the hospital through an IV. They use it to treat osteosarcoma: […] Successful surgery for osteosarcoma means getting rid of all the cancer. To accomplish that, surgeons will need to remove some of the bone and surrounding tissue. They’ll try to save and rebuild as much of the limb as possible. […] The two types of surgery for osteosarcoma are: […] Recovery from osteosarcoma treatment for you or your child will require rehabilitation and follow-up care. You may need to use crutches, a cane, or a walker for some time. […] With physical therapy and follow-up care, most people notice continued improvement in strength and mobility for one to two years after surgery for osteosarcoma.

• #81 Osteosarcoma | Bone Cancer Research Trust

  https://www.bcrt.org.uk/information/information-by-type/osteosarcoma/

  Occasionally, in special circumstances, radiotherapy might be recommended to treat osteosarcoma following surgery. […] Proton Beam Therapy (PBT) is a type of radiotherapy that uses beams of ‘protons’ (energised particles), instead of beams of X-rays (photons), that are used in conventional radiotherapy. […] The overall 5-year survival rate for osteosarcoma is around 50-55%. […] After finishing treatment, osteosarcoma patients will require follow-up care. Outpatient hospital visits will be needed on a regular basis for the first few years after treatment, and then probably yearly after that. […] If the cancer returns it will require more treatment. This will probably involve more chemotherapy and sometimes further surgery.

• #82 Osteosarcoma | Bone Cancer Research Trust

  https://www.bcrt.org.uk/information/information-by-type/osteosarcoma/

  Occasionally, in special circumstances, radiotherapy might be recommended to treat osteosarcoma following surgery. […] Proton Beam Therapy (PBT) is a type of radiotherapy that uses beams of ‘protons’ (energised particles), instead of beams of X-rays (photons), that are used in conventional radiotherapy. […] The overall 5-year survival rate for osteosarcoma is around 50-55%. […] After finishing treatment, osteosarcoma patients will require follow-up care. Outpatient hospital visits will be needed on a regular basis for the first few years after treatment, and then probably yearly after that. […] If the cancer returns it will require more treatment. This will probably involve more chemotherapy and sometimes further surgery.

• #83 Osteosarcoma: Symptoms, Tests & Treatments

  https://www.healthline.com/health/osteosarcoma

  Chemotherapy and surgery are effective at treating osteosarcoma. […] Chemotherapy is often administered before surgery. This treatment method uses drugs that help shrink and kill cancerous cells. The length of chemotherapy treatment varies and may depend on whether the cancer has spread to other parts of the body. For example, if your child’s cancer hasn’t spread, their doctor may recommend six months of chemotherapy before surgery. Once your child finishes the course of chemotherapy, surgery will be used to remove any remaining tumors. […] In most cases, surgeons can save the cancerous limb. They can surgically remove the tumor and surrounding bone, and replace the missing bone with an artificial one. Chemotherapy may resume after surgery to destroy any microscopic cancer cells. […] Bone cancer can recur, even after chemotherapy and surgery. Your child will need follow-up CT scans, bone scans, and X-rays to check for new tumors. […] Chemotherapy and surgery may not completely cure osteosarcoma, and cancerous cells may continue to grow and spread. Your child’s doctor may suggest amputation to stop the spread of cancerous cells. This is the surgical removal of the cancerous limb.

• #84 Osteosarcoma Treatment & Management: Approach Considerations, Medical Therapy, Biopsy

  https://emedicine.medscape.com/article/1256857-treatment

  As usual for any child with cancer, consultations should be made with an oncologist, as well as with any provider with a subspecialty related to the specific clinical circumstances. […] Further cycles of chemotherapy generally necessitate inpatient admission for administration and monitoring. […] Patients may require admission for a multitude of other medical problems during their chemotherapy treatment phase. […] To monitor for recurrence, patients should continue to have blood work and radiographic scans on an outpatient basis, with the frequency decreasing over time.

• #85 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The main improvement in the treatment of localized osteosarcoma over the past 30 years has been the advent of chemotherapy. […] Neoadjuvant chemotherapy has the potential advantage of delivering widespread systemic treatment quickly and reducing the size of the primary cancer in order to increase the number of patients eligible for limb-sparing surgical treatment. […] Since the 1980s, the treatment of osteosarcoma has been further improved with the addition of neoadjuvant chemotherapy to conventional surgery and adjuvant chemotherapy. […] Certain chemotherapy agents are more effective in treating osteosarcoma than others. […] Radiation therapy has a limited role in the treatment of localized osteosarcoma. […] The most important factors in long-term outcomes of patients with localized osteosarcoma are the degree of anti-cancer response to neoadjuvant chemotherapy and whether or not the cancer could be completely removed with surgery.

• #86 Osteosarcoma | Bone Cancer Research Trust

  https://www.bcrt.org.uk/information/information-by-type/osteosarcoma/

  Occasionally, in special circumstances, radiotherapy might be recommended to treat osteosarcoma following surgery. […] Proton Beam Therapy (PBT) is a type of radiotherapy that uses beams of ‘protons’ (energised particles), instead of beams of X-rays (photons), that are used in conventional radiotherapy. […] The overall 5-year survival rate for osteosarcoma is around 50-55%. […] After finishing treatment, osteosarcoma patients will require follow-up care. Outpatient hospital visits will be needed on a regular basis for the first few years after treatment, and then probably yearly after that. […] If the cancer returns it will require more treatment. This will probably involve more chemotherapy and sometimes further surgery.

• #87 Bone Cancer: Diagnosis and Treatment Principles | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0815/p205.html

  Osteosarcoma, the most common bone cancer, most often occurs in children and adolescents. […] Use of neoadjuvant and adjuvant chemotherapy, in combination with surgery, has improved survival rates to nearly 80% for patients with localized disease, and 90% to 95% of patients do not require limb amputation. […] The current mainstay of treatment for osteosarcoma is neoadjuvant chemotherapy, followed by surgical resection and adjuvant chemotherapy. […] The current five-year survival rate is more than 70% in persons with nonmetastatic disease. […] Neoadjuvant chemotherapy regimens aim to cause tumor necrosis and decrease primary tumor size, as well as the number and size of pulmonary metastases. […] Surgical excision is the definitive treatment for osteosarcoma. […] Currently, 90% to 95% of patients with extremity osteosarcoma avoid amputation with successful limb-sparing resections. […] Osteosarcoma most often metastasizes to the pulmonary system through blood; 20% of patients initially present with evidence of lung metastases on computed tomography. […] Treatment of metastases relies on chemotherapy.

• #88 Immunotherapy in Osteosarcoma Treatment: What to Know

  https://osinst.org/immunotherapy/

  The standard treatment for osteosarcoma involves a combination of chemotherapy and surgery, and it has been that way for about 40 years. For localized cancers, the relative five-year survival rate of this treatment protocol is 76%. […] However, that rate dips steeply for osteosarcoma that has spread through the body. For osteosarcoma that has spread to nearby structures or lymph nodes, five-year survival is 64%, and five-year survival drops to 24% if the cancer has spread to distant parts of the body. That is why researchers are working hard to develop new osteosarcoma treatments, and immunotherapy in particular offers promise. […] Chemotherapy — a key feature of the standard treatment for osteosarcoma — uses powerful drugs to attack abnormal cells throughout the body, but the treatment comes with numerous downsides. Chemotherapy does not distinguish between cancer cells and healthy cells, resulting in toxicity and severe side effects for the patient, including nausea, vomiting, hair loss, weight loss, and fatigue. In addition, some osteosarcomas do not respond to chemotherapy, and chemotherapy can miss microscopic tumor cells that then go on to cause a relapse.

• #89 Immunotherapy in Osteosarcoma Treatment: What to Know

  https://osinst.org/immunotherapy/

  The standard treatment for osteosarcoma involves a combination of chemotherapy and surgery, and it has been that way for about 40 years. For localized cancers, the relative five-year survival rate of this treatment protocol is 76%. […] However, that rate dips steeply for osteosarcoma that has spread through the body. For osteosarcoma that has spread to nearby structures or lymph nodes, five-year survival is 64%, and five-year survival drops to 24% if the cancer has spread to distant parts of the body. That is why researchers are working hard to develop new osteosarcoma treatments, and immunotherapy in particular offers promise. […] Chemotherapy — a key feature of the standard treatment for osteosarcoma — uses powerful drugs to attack abnormal cells throughout the body, but the treatment comes with numerous downsides. Chemotherapy does not distinguish between cancer cells and healthy cells, resulting in toxicity and severe side effects for the patient, including nausea, vomiting, hair loss, weight loss, and fatigue. In addition, some osteosarcomas do not respond to chemotherapy, and chemotherapy can miss microscopic tumor cells that then go on to cause a relapse.

• #90 Localized Osteosarcoma

  https://www.texasoncology.com/types-of-cancer/bone-cancer/osteosarcoma-overview/localized-osteosarcoma

  The main improvement in the treatment of localized osteosarcoma over the past 30 years has been the advent of chemotherapy. […] Neoadjuvant chemotherapy has the potential advantage of delivering widespread systemic treatment quickly and reducing the size of the primary cancer in order to increase the number of patients eligible for limb-sparing surgical treatment. […] Since the 1980s, the treatment of osteosarcoma has been further improved with the addition of neoadjuvant chemotherapy to conventional surgery and adjuvant chemotherapy. […] Certain chemotherapy agents are more effective in treating osteosarcoma than others. […] Radiation therapy has a limited role in the treatment of localized osteosarcoma. […] The most important factors in long-term outcomes of patients with localized osteosarcoma are the degree of anti-cancer response to neoadjuvant chemotherapy and whether or not the cancer could be completely removed with surgery.

• #91 Recurrent Osteosarcoma – Virginia Cancer Institute

  https://www.vacancer.com/cancer/bone-cancer/osteosarcoma-overview/recurrent-osteosarcoma/

  Osteosarcoma that has not responded to treatment or has returned after an initial response to treatment is considered recurrent. Recurrent osteosarcoma occurs in 30-50% of patients with initial localized disease and 80% of patients presenting with metastatic disease. The most common site to which osteosarcoma spreads, or metastasizes, is the lungs. The most common site of recurrence is also the lungs. A long interval between the primary diagnosis and the appearance of recurrent disease is associated with a better prognosis. Also, patients with recurrence of their disease in the lung have a better prognosis than patients with other distant metastases because they may sometimes be cured if the cancer can be completely removed with surgery, followed by chemotherapy. […] The following is a general overview of treatment for recurrent osteosarcoma. Treatment may consist of surgery, chemotherapy, or a combination of the two. Multi-modality treatment, which is treatment using two or more techniques, is increasingly recognized as an important approach for increasing a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment.

• #92 Bone Cancer Treatment & Pharmacologic Management

  https://www.cancertherapyadvisor.com/ddi/bone-cancer-treatment-pharmacologic-management/

  When the tumor originates primarily within the bone marrow (intramedullary) but also extends to the surface of the bone and is classified as high-grade, NCCN-recommended preoperative chemotherapy regimens include cisplatin/doxorubicin and cisplatin, doxorubicin, and high-dose methotrexate (MAP), although certain older adult patients may benefit from immediate surgery. MAP is preferred in patients younger than 40 years with excellent performance status. Cisplatin, doxorubicin, ifosfamide, and high-dose methotrexate may also be considered. […] After wide excision, if there are negative margins with good histologic response to surgery (viable tumor is 10% of the tumor area), preoperative chemotherapy may be continued; negative margins with poor histologic response (viable tumor is 10% of the tumor area) indicate that chemotherapy may be changed. With positive margins and good response, chemotherapy and re-excision with or without radiotherapy may be considered. Those with positive margins and poor response may consider changing chemotherapy in addition to re-excision, with or without radiotherapy. Growth factor support should be a component of chemotherapy.

• #93 Osteosarcoma: A Review of Diagnosis, Management, and Treatment Strategies – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/october-2010/osteosarcoma-a-review-of-diagnosis-management-and-treatment-strategies/

  Abstract: Despite significant advancements in the diagnosis and treatment of osteosarcoma to date, overall survival has remained relatively constant for over 2 decades. […] Modern multi-agent chemotherapy has resulted in the greatest improvement in overall survival to date, and it is very likely that future improvements in survival will arise from combination-targeted chemotherapy in addition to conventional treatment. […] Accurate diagnosis and staging are fundamental prerequisites for appropriate treatment planning, patient education and guidance, and patient participation in clinical trials. […] Surgical treatment demands complete extirpation of the tumor together with any previously placed biopsy tract, drain tract, or potentially contaminated tissue. […] The value of chemotherapy for the treatment of osteosarcoma has been clearly proven in randomized clinical trials.

• #94 Innovative approaches for treatment of osteosarcoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8899335/

  However, the drug also has extreme side effects such as acute and chronic renal failure, peripheral neuropathy, ototoxicity, hypomagnesemia, gastrointestinal disorders, and hemorrhage. […] IFO also has dramatic side effects such as hemorrhagic cystitis, acute kidney injury, Fanconis syndrome, interstitial nephritis, glomerular disease, and encephalopathy. […] There is an urgent need for more effective and less toxic treatment for OS patients. […] This review has discussed the current treatment for OS and possible ways to develop novel therapeutic agents for the disease with the aim of less toxic and more effective treatment.

• #95 Osteosarcoma treatment market | Osteosarcoma unmet needs

  https://www.delveinsight.com/blog/osteosarcoma-treatment-market

  Although the Osteosarcoma treatment market has witnessed a lot of improvements in the last many decades, there still remains a lot to cover. There are a lot of unmet needs in the market that continues to widen the treatment gap; Multi-drug-resistance is one of the significant ones. […] To bridge these treatment gaps, many pharma, and biotech companies in the Osteosarcoma treatment market including Eisai Limited, Bayer, Exelixis, Nektar Therapeutics, Y-mAbs Therapeutics, GlaxoSmithKline, Novartis, Aadi Bioscience, Eleison Pharmaceuticals, Aurora biopharma, BioAtla, Iovance Biotherapeutics, Bristol-Myers Squibb, Cellestia Biotech, among others are developing novel therapeutic strategies. […] As important it is to understand the nature of the tumor, equally important are the efforts to prioritize the development of therapies that target the tumor, shrink their size, and halt their progression.

• #96 Advancing therapy for osteosarcoma | Nature Reviews Clinical Oncology

  https://www.nature.com/articles/s41571-021-00519-8

  Improving the survival of patients with osteosarcoma has long proved challenging, although the treatment of this disease is on the precipice of advancement. […] Indeed, osteosarcoma cells are known to express a number of surface proteins that might be of therapeutic relevance, including B7-H3, GD2 and HER2, which can be targeted using antibody-drug conjugates and/or adoptive cell therapies. […] Immune-based targeted therapies, including monoclonal antibodies, antibody-drug conjugates and chimeric antigen receptor T cells targeting cell-surface proteins commonly overexpressed in osteosarcoma, are in active clinical development. […] Owing to advances in biological understanding, the development of robust preclinical models, the feasibility of rapid clinical testing and novel treatment concepts, long-awaited improvements in the outcomes of patients with osteosarcoma are anticipated in the near future.

• #97 Future Directions in the Treatment of Osteosarcoma

  https://www.mdpi.com/2073-4409/10/1/172

  Beyond MAP chemotherapy, few current therapies have a clinically meaningful impact for patients with osteosarcoma. An international, cooperative, and collaborative translational approach is required to augment current understanding and identify potential means to improve patient outcomes. Current evidence suggests that the biology of osteosarcoma is frustratingly complex with heterogenous putative oncogenic mechanisms found in patients with osteosarcoma. Research using DNA and RNA analyses must continue to elucidate both patient- and subtype-specific molecular hallmarks. Such work is required to determine both predictive and prognostic immune and molecular biomarkers at diagnosis and during therapy for patients with osteosarcoma. Ultimately, this work may lead to precision medicine-based approaches for patients with osteosarcoma and hopefully lead to a clinically meaningful improvement in outcomes for patients with osteosarcoma.

• #98 Advancing therapy for osteosarcoma | Nature Reviews Clinical Oncology

  https://www.nature.com/articles/s41571-021-00519-8

  Improving the survival of patients with osteosarcoma has long proved challenging, although the treatment of this disease is on the precipice of advancement. […] Indeed, osteosarcoma cells are known to express a number of surface proteins that might be of therapeutic relevance, including B7-H3, GD2 and HER2, which can be targeted using antibody-drug conjugates and/or adoptive cell therapies. […] Immune-based targeted therapies, including monoclonal antibodies, antibody-drug conjugates and chimeric antigen receptor T cells targeting cell-surface proteins commonly overexpressed in osteosarcoma, are in active clinical development. […] Owing to advances in biological understanding, the development of robust preclinical models, the feasibility of rapid clinical testing and novel treatment concepts, long-awaited improvements in the outcomes of patients with osteosarcoma are anticipated in the near future.

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