Treatments for 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

If an osteosarcoma does not respond to drugs used in earlier treatments or if it comes back, the following drugs may be used:

• gemcitabine (Gemzar)
• docetaxel (Taxotere) and gemcitabine
• cyclophosphamide (Procytox) and etoposide (Vepesid, VP-16)
• cyclophosphamide and topotecan (Hycamtin)
• high-dose ifosfamide, with or without etoposide
• ifosfamide, carboplatin (Paraplatin, Paraplatin AQ) and etoposide
• high-dose methotrexate, etoposide and ifosfamide

Chemotherapy combinations that use high-dose methotrexate are not used very often for adults who are 40 or older. This is because there is a higher chance that the kidneys will not move the drug out of the body quickly enough, which can cause serious side effects.

Surgery is used to treat osteosarcoma tumours after chemotherapy. The type of surgery you have depends mainly on where the tumour is, how big it is and how much it has responded to chemotherapy.

The main goal of surgery is to remove the whole tumour along with a margin of normal tissue around it. The other tissues or structures that have to be removed will depend on where the cancer has spread.

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. This type of surgery is also called an en bloc resection. It may be used for osteosarcoma of the jaw, shoulder, pelvis, arm or leg.

Limb-sparing surgery removes the tumour without removing (amputating) the whole arm or leg (the limb). Surgeons remove all of the tumour and any of the soft tissues where the bone cancer has spread. After this type of surgery, the limb is reconstructed using bone and skin grafts. Limb-sparing surgery may be used to treat osteosarcoma in the arm, leg and pelvis.

Amputation removes all or part of the arm or leg with the tumour. It may be done if the osteosarcoma has grown into the nerves or blood vessels, or if the tumour is very big. Amputation may be done if the cancer comes back in the same area after limb-sparing surgery. Most people who have an amputation will use an artificial limb (prosthesis) after surgery.

Reconstructive surgery is done at the same time as surgery to remove the tumour. Bone and tissue grafts may be done to replace tissues removed during surgery. An endoprosthesis may be used to replace a joint removed with surgery.

Surgery for metastases may be used to treat osteosarcoma that has come back (recurred) as lung metastases if it has been more than a year since treatment ended. If surgery is an option for lung metastases, doctors will often use a wedge resection to remove the tumours along with a triangle-shaped piece of the lung around the tumour. Other options are removing a lobe of the lung or the whole lung. Surgery to remove metastases is often done at the same time as surgery to remove the primary bone tumour.

External beam radiation therapy may be used to treat osteosarcoma after surgery if the tumour wasn’t completely removed. It may be used instead of surgery if the tumour can’t be removed with surgery.

Radiation therapy is also used to treat pain and control the symptoms of osteosarcoma that has metastasized or come back (recurred).

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials for bone cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.