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Treatment Options for Osteosarcoma

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Janet L. Kwiatkowski, MD
Last Modified: November 1, 2001

Dear OncoLink "Ask the Experts,"
My 18-year-old son was recently diagnosed with an osteosarcoma of the distal femur. What is the treatment?

Janet L. Kwiatkowski, MD, OncoLink's Pediatric Oncology Section Editor, responds:

Thank you for your question.

Osteosarcoma is a malignant bone tumor with a peak incidence in the adolescent age group. The bones most commonly involved are the distal femur, proximal tibia, and proximal humerus. Osteosarcoma can metastasize, particularly to the lungs. Treatment and prognosis depend upon the extent of the tumor at diagnosis.

There are two main components to treatment, chemotherapy and surgery. An initial biopsy is undertaken to determine the diagnosis. Chemotherapy is often then administered prior to definitive surgery in an attempt to make the surgical resection easier. The tumor response to chemotherapy has prognostic significance. An equally important role of chemotherapy is to treat microscopic areas of spread (micrometastases). Chemotherapeutic agents commonly used in the treatment of osteosarcoma include methotrexate, adriamycin, cisplatin, ifosphamide, and other agents. Several of these medications are often given in combination.

Surgical management requires complete removal of the tumor with a margin of normal tissue. Two main surgical approaches are used, amputation and limb-salvage procedures. The choice of technique must be individualized and is based on the ability to obtain a complete tumor resection as well as functional considerations.