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After completing a thorough evaluation of the patient, the team develops an individualized treatment strategy. The specific approach depends upon the location and size of the tumor and the needs of the patient. Osteosarcoma treatment at Mayo Clinic is planned with two goals in mind: to cure the cancer and to preserve as much function as possible.
A person with osteosarcoma generally receives a combination of cancer-fighting drugs (chemotherapy) followed by surgery on the tumor. Chemotherapy is given to control the spread of the disease and to shrink the tumor making surgery more manageable. Clinical trials related to osteosarcoma are available at Mayo Clinic.
In about 90 percent of osteosarcoma cases of the arm or leg, the limb can be saved. The decision to save the limb depends upon the tumor's size, location's relationship to adjacent structures and the response to chemotherapy given before surgery.
Limb salvage techniques at Mayo Clinic include rotationplasty, bone grafts (autografts and allografts) and implantation of prosthetic joints.
In this procedure a surgeon harvests the patient's own bone tissue to implant at the site where cancerous tissue is removed. One common form of this procedure is called free vascularized fibular grafting. In this procedure surgeons harvest the smaller of the two lower leg bones as well as its blood vessels to implant at the cancer site. Mayo Clinic surgeons have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) techniques include a greater chance for the bone to heal and a reduced chance for infection.
Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas where a patient experiences an osteosarcoma tumor. This is called an allograft procedure. Surgeons at Mayo Clinic have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system.
Typically used for young or athletic patients who have osteosarcoma near the knee joint, rotationplasty can allow a patient to run or walk with near-normal function. In the procedure, an orthopedic surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle becomes the "knee." Specialists then fit the patient with a prosthetic ankle and foot.
Surgeons can replace sections of bone with specialized prosthetic implants. Expandable and solid implants of many different sizes are available. Surgeons consider whether the patient will experience further bone growth before recommending prosthetic implants.
Following surgery, additional chemotherapy is often recommended to improve the chances that the cancer cells have been eliminated. This chemotherapy course may last 8 to 12 months. In general, radiation is used only in osteosarcoma cases for which surgery is impossible, unacceptable to the patient or impractical because of the tumor's location or other factors.
For individuals whose cancer has spread, treatment is more difficult and depends on the location of the tumors. Osteosarcoma metastases occur more often in the lung than at other sites. Mayo Clinic physicians provide individualized treatment programs to control cancer and obtain long-term remission. These approaches may include surgery, radiation, radiofrequency ablation, cryoablation and treatments under investigation in clinical trials.
Patients with osteosarcoma lung metastases are usually treated with surgery of the lungs, if possible. Aerosolized granulocyte macrophage colony-stimulating factor therapy is an option for some patients.
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