How osteosarcoma is treated

Different types of treatment are available for children with osteosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

If it is suspected that the problem is osteosarcoma, before the first biopsy, your doctor may recommend a specialist called an orthopedic oncologist.

Three kinds of standard treatment are used:

• Surgery (taking out the cancer in an operation).
• Chemotherapy (using drugs to kill cancer cells).
• Radiation therapy (using high-dose x-rays to kill cancer cells).

In addition to these standard treatments, targeted therapy is being tested in clinical trials. Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Angiogenesis inhibitors and monoclonal antibodies are two types of targeted therapies being studied in the treatment of osteosarcoma.

Angiogenesis inhibitors are substances that block the growth of new blood vessels. In cancer treatment, angiogenesis inhibitors prevent the growth of new blood vessels needed for tumors to grow.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

All patients with localized osteosarcoma should have surgery to remove the tumor and some of the healthy tissue around the cancer, if possible. Most patients with osteosarcoma in a limb can be treated with limb-sparing surgery and do not require amputation (removal of the limb). If a fracture is found at diagnosis or during chemotherapy before surgery, limb-sparing surgery may still be possible in some cases. Sometimes all or part of an arm or leg may have to be removed to make sure that all of the cancer is taken out. If cancer has spread to lymph nodes, the lymph nodes will be removed (lymph node dissection).

In patients with osteosarcoma that has not spread beyond the bone, researchers have found no difference in overall survival whether patients have limb-sparing surgery or whether they have surgery with amputation. When the cancer can be taken out without amputation, artificial devices or bones from other places in the body can be used to replace the bone that was removed. The process of rebuilding (reconstructing) a part of the body changed by previous surgery is called reconstructive surgery. Options for reconstructive surgery in patients with osteosarcoma depend on many factors, including where the tumor is, how large it is, the age of the patient, and how much the patient will continue to grow.