Treatments for osteocarcoma may involve a combination of therapies including surgery, radiation and/or chemotherapy. In most cases, children receive chemotherapy before surgery (neoadjuvant), a surgical procedure to remove the tumor and additional chemotherapy after surgery (adjuvant). Treatment options will vary greatly, depending on your child's situation. Your child's doctor and other members of your care team will discuss the options with you in-depth. Prompt medical attention and aggressive therapy are important for the best prognosis.
Children with osteosarcoma are treated through the Bone and Soft Tissue Program at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital.
Surgery for Osteosarcoma
Depending on the size and location of the tumor and whether the tumor has spread, your child may receive one of the following surgical treatments:
- Limb-salvage surgery helps preserve the limb by removing the tumor and wide margins of healthy tissue surrounding the tumor. This type of surgery is done whenever possible as long as the tumor can be completely removed using this method. The goal of limb-salvage surgery is to preserve as much use of the limb as possible and preserve limb function.
- Amputation may be necessary if the tumor cannot be completely removed (for example, if it involves the nerves and blood vessels) or if limb function cannot be preserved through limb-salvage surgery. If amputation is necessary, your child may be fitted for a prosthesis following surgery.
- Rotationplasty is a partial amputation that preserves a cancer-free lower leg, attaches it to the thighbone and uses the ankle as a knee joint—especially useful in very young children where limb length can be an issue. This operation may be performed when the tumor is very large and complete removal would be difficult.
Surgery at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is personalized to help your child achieve the best functional and cosmetic outcome and to allow them to remain active and healthy. Depending on the type of surgery your child receives, your child may have to avoid certain physical activities following treatment. Limb-salvage surgery can leave an arm or leg fragile and increase the risk of fracture. As a result, patients will need to avoid high-stress physical activities, such as skiing, skate-boarding or bike riding. Children who require partial or complete limb amputations will be fitted with a prosthesis and need to undergo physical therapy to adapt to using it.
Talk to your child’s pediatric oncologist or orthopedic surgeon for more information on these procedures.
If the osteosarcoma has spread to other parts of the body, such as the lungs, additional surgery may be required, and our oncologic surgeons will remove any metastases that may have formed.
Chemotherapy for Osteosarcoma
Chemotherapy is a group of drugs that interfere with the cancer cell’s ability to grow or reproduce.
- Different groups of chemotherapy drugs work in varied ways to fight cancer cells and shrink tumors.
- Often, a combination of chemotherapy drugs is used.
- Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
Does chemotherapy cause side effects?
While chemotherapy can be quite effective in treating certain cancers, the drugs cannot tell the difference between normal healthy cells and cancer cells. Because of this, your child may experience adverse side effects during treatment. Understanding these side effects can help you, your child and your care team prepare for, and, in some cases, prevent these symptoms from occurring.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
- orally, as a pill to swallow
- intramuscularly (or IM), as an injection into the muscle or fat tissue
- intravenously (or IV), directly to the bloodstream
- intrathecally, with a needle directly into the fluid surrounding the spine
Rehabilitation is an extremely important part of your child’s osteosarcoma care. This includes physical and occupational therapy, as well as help adapting to social situations. Your child’s physician will discuss what types of lifestyle changes may be necessary, and our experienced physical and occupational therapists will work to optimize his mobility after surgery.
Some cases of osteosarcoma require partial or complete amputation of an arm or leg. The NOPCO (National Orthotics and Prosthetics Company) Brace Shop at Boston Children's Hospital provides each patient with an expertly made, customized prosthesis, and our physical therapists help children adjust to using them.
Supportive care is treatment to prevent and treat infections, side effects of treatments and complications. The goal is to keep your child comfortable during treatment. It also is an important part of preventing short- and long-term complications of the disease and treatment.
What is the long-term outlook for children with osteosarcoma?
Your child’s prognosis (chance of recovery) and treatment options depend on a number of different factors, including:
- the extent of the disease
- the size and location of the tumor
- the presence or absence of metastasis
- the tumor's response to therapy
- the age and overall health of your child
- your child's tolerance of specific medications, procedures or therapies
- new developments in treatment
In general, osteosarcomas in the limbs tend to be more treatable. Osteosarcomas in other locations are more difficult to treat and require more aggressive therapy. Prompt medical attention and appropriate therapy are important for the best prognosis.
What treatments are available for relapsed or recurrent osteosarcoma?
Unfortunately, about 40 percent of children treated for osteosarcoma will experience relapse, or a return of the disease.
Our pediatric oncologists and surgeons are experienced in treating relapsed osteosarcoma. For children with relapsed osteosarcoma, we offer the highest standard of care including additional surgery and chemotherapy. We also provide access to newly developed treatments through phase I and phase II clinical trials at Dana-Farber/Boston Children’s and the Children’s Oncology Group.