Treatment
Standard treatment for osteosarcoma is most often a combination of surgery and chemotherapy. Your physician may also discuss radiation therapy/proton therapy in certain situations. The specific treatment plan depends on the type, location and stage of the cancer, as well as the patient's overall health. The doctor may recommend any of the following treatments for osteosarcoma.
Surgery
Previously, the only treatment option for patients with osteosarcomas in an arm or leg was amputation (removal of the limb). With new advances in surgical techniques, and the addition of chemotherapy, doctors can usually perform limb-sparing surgery for patients with tumors in these areas. In this procedure, the doctor removes the tumor while saving nearby tendons, nerves, and blood vessels, to allow the patient to retain use of the arm or leg. After removing the tumor, the doctor replaces the missing bone with a bone graft from another part of the body or a prosthetic replacement. A wide local excision may also be recommended which involves removing the cancer as well as some healthy tissue around it. The doctor may also recommend a rotationplasty when a joint such as the knee needs to be removed with the tumor and can be replaced by the ankle joint. In some advanced cases where the cancer has invaded nearby structures, amputation may still be the best option. The doctors often administer chemotherapy to shrink the tumor before surgery and to reduce the risk of the cancer coming back after surgery. After all of these procedures, the patient will require physical therapy and rehabilitation to regain use of their limb is important. Also, growing children may need additional surgeries to replace the internal prosthesis with a bigger one.
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Most of these medications are given through the vein (intravenously). Chemotherapy is often given before and after surgery for osteosarcoma, to increase the chances of a successful operation. Chemotherapy may also be given to patients whose cancer has metastasized (spread) to other parts of the body.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Radiation therapy is not usually used for the treatment of osteosarcoma, but may be used before or after surgery to kill any remaining cancer cells. Doctors may also use radiation therapy to treat some patients whose osteosarcoma cannot be removed with surgery, or to relieve symptoms of the disease in patients with advanced osteosarcoma. The doctor may also recommend a radiopharmaceutical drug to treat osteosarcoma. This is a radioactive drug that targets areas of bone growth. The drug is injected into the veins and collects in the bones, where it gives off radiation.
Proton Therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation in some of the surrounding tissue and to healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and maybe beneficial in certain situations and tumor locations.
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Targeted Therapy
Targeted therapy is a type of treatment that attacks a specific biologic feature of the tumor in order to eliminate it. Targeted therapy for osteosarcoma includes anti- angiogenesis agents, while a number of newer agents like monoclonal antibodies, viral therapy, or kinase inhibitors are being evaluated in clinical trials. Anti-angiogenesis agents prevent the tumor from forming new blood vessels that provide it with the nutrients it needs to grow. Other types of targeted therapy attack overproduced enzymes or proteins on the surface of the cancer cells. Targeted therapy prevents these proteins and enzymes from stimulating the growth of cancer cells.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be in comparison to the currently used drugs for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
