Osteosarcoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].
Overview
The mainstay of therapy for osteosarcoma is surgical resection. Rather than using the standard staging system, a simpler system is often used when planning treatment for osteosarcoma. This system divides osteosarcomas into 2 groups: localized osteosarcoma and metastatic osteosarcoma.
Surgery
- Current standard treatment for osteosarcoma is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection.[1][2][3][4]
- If a limb-salvage procedure is feasible, a course of multidrug chemotherapy precedes surgery to downstage the tumor, followed by wide resection of the bone and insertion of an endoprosthesis.
- The outcome depend on different factors such as age, sex, site, size, and type but the most important predictor is the histologic degree of necrosis post induction chemotherapy; 90% histologic necrosis is associated with much better prognosis.
- Although about 90% of patients are able to have limb-salvage surgery, complications, such as infection, prosthetic loosening and non-union, or local tumor recurrence may cause the need for further surgery or amputation.
- Rather than using the standard staging system, a simpler system is often used when planning treatment for osteosarcoma. This system divides osteosarcomas into 2 groups: localized osteosarcoma and metastatic osteosarcoma.
Localized Osteosarcoma
- The cancer is only in the bone where it started and may be in the tissues next to the bone.[5][6][7]
- Localized osteosarcomas are further divided into 2 groups: localized resectable osteosarcoma and localized unresectable osteosarcoma.
Localized resectable osteosarcoma
Resectable tumors are those in which all the visible tumor can be removed by surgery and the cancer has not spread to other parts of the body.
- Surgery is the primary treatment for localized resectable osteosarcoma.
- Surgery is usually the only treatment used for low-grade, localized resectable osteosarcomas (chemotherapy is not given).
- The types of surgery done include:
- Limb-sparing surgery
- Amputation
- Reconstruction
- Rotationplasty
- Chemotherapy may be offered for localized resectable osteosarcoma, usually given before surgery.
- Chemotherapy is also given after surgery to destroy any remaining cancer cells.
Localized unresectable osteosarcoma
Localized unresectable tumors have not spread to other parts of the body, but they cannot be completely removed by surgery. They may be too large or too close to vital structures in the body to be resected.
- Chemotherapy is usually the first treatment offered for localized unresectable osteosarcoma.
- If the tumor shrinks enough to become resectable, it is then treated with surgery.
- If the osteosarcoma is still unresectable after chemotherapy, radiation therapy may be given to control pain.
Metastatic Osteosarcoma
- Metastatic osteosarcoma has already spread to distant parts of the body at the time of diagnosis. It usually spreads to the lungs.[8][9][10][11]
Lung Metastasis
- Treatment of osteosarcoma with lung metastasis may include combination chemotherapy followed by surgery to remove the primary cancer and the cancer that has spread to the lung.
Bone metastasis or bone with lung metastasis
- Osteosarcoma spread to a distant bone and/or the lung.
- Treatment may include combination chemotherapy followed by surgery to remove the primary tumor and the cancer that has spread to other parts of the body.
- More chemotherapy is given after surgery.
- If some tumors remain unresectable after chemotherapy, radiation therapy may be given to control pain.
Recurrent osteosarcoma
Recurrent osteosarcoma means that the bone cancer has come back (has recurred) after it was treated. In rare cases, it may recur in the same location as the original cancer (local recurrence). Usually it recurs in the lungs. Treatment of recurrent osteosarcoma of the bone may include the following:[9][12][13][8]
- Surgery to remove the tumor with or without chemotherapy.
- If the cancer recurs in the same location on an arm or leg after limb-sparing surgery, amputation of the limb may be recommended.
- Chemotherapy may be offered for recurrent osteosarcoma to control the growth of the tumor.
- Radiation therapy may be offered to help relieve symptoms.
- Samarium with or without stem cell transplant using the patient's own stem cells, as palliative treatment to relieve pain and improve the quality of life.
References
- ↑ Han G, Bi WZ, Xu M, Jia JP, Wang Y (August 2016). "Amputation Versus Limb-Salvage Surgery in Patients with Osteosarcoma: A Meta-analysis". World J Surg. 40 (8): 2016–27. doi:10.1007/s00268-016-3500-7. PMID 27116252.
- ↑ {{cite journa<ref name="pmid26660089">Anderson ME, Wu JS, Vargas SO (May 2016). "CORR (®) Tumor Board: Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients with Osteosarcoma of the Proximal Tibia?". Clin. Orthop. Relat. Res. 474 (5): 1110–2. doi:10.1007/s11999-015-4660-8. PMID 26660089.
- ↑ Ma L, Zhou Y, Zhu Y, Lin Z, Wang Y, Zhang Y, Xia H, Mao C (March 2016). "3D-printed guiding templates for improved osteosarcoma resection". Sci Rep. 6: 23335. doi:10.1038/srep23335. PMC 4800413. PMID 26997197.
- ↑ Kamal AF, Widyawarman H, Husodo K, Hutagalung EU, Rajabto W (July 2016). "Clinical Outcome and Survival of Osteosarcoma Patients in Cipto Mangunkusumo Hospital: Limb Salvage Surgery versus Amputation". Acta Med Indones. 48 (3): 175–183. PMID 27840351.
- ↑ Cao H, Zhang H, Zou H (December 2018). "Immunotherapeutic approaches in pediatric osteosarcoma". Minerva Pediatr. 70 (6): 635–636. doi:10.23736/S0026-4946.17.04930-1. PMID 28353326.
- ↑ Shives TC, Dahlin DC, Sim FH, Pritchard DJ, Earle JD (June 1986). "Osteosarcoma of the spine". J Bone Joint Surg Am. 68 (5): 660–8. PMID 3459729.
- ↑ Shimizu T, Fuchimoto Y, Okita H, Fukuda K, Kitagawa Y, Ueno S, Kuroda T (December 2018). "A curative treatment strategy using tumor debulking surgery combined with immune checkpoint inhibitors for advanced pediatric solid tumors: An in vivo study using a murine model of osteosarcoma". J. Pediatr. Surg. 53 (12): 2460–2464. doi:10.1016/j.jpedsurg.2018.08.023. PMID 30266483.
- ↑ 8.0 8.1 Jiang F, Shi Y, Li GJ, Zhou F (February 2015). "A meta-analysis of limb-salvage versus amputation in the treatment of patients with Enneking‡U pathologic fracture osteosarcoma". Indian J Cancer. 51 Suppl 2: e21–4. doi:10.4103/0019-509X.151997. PMID 25712836.
- ↑ 9.0 9.1 Xu G, Zheng K (August 2013). "Successful management of early recurrence after surgery for primary rib osteosarcoma in an adult". Interact Cardiovasc Thorac Surg. 17 (2): 431–2. doi:10.1093/icvts/ivt173. PMC 3715179. PMID 23599185.
- ↑ Rapicetta C, Lococo F, Carlinfante G, Ricchetti T, Paci M (August 2017). "Extraskeletal Osteosarcoma Arising from the Pleura". Lung. 195 (4): 523–525. doi:10.1007/s00408-017-0018-1. PMID 28551716.
- ↑ Rimbas M, Attili F, Inzani F, Larghi A (June 2016). "A Large Abdominal Osteosarcoma". J Gastrointestin Liver Dis. 25 (2): 135. doi:10.15403/jgld.2014.1121.252.abo. PMID 27308640.
- ↑ Han G, Wang Y, Bi W, Jia J, Wang W, Xu M, Zheng X, Mei L, Yang M (September 2015). "Reconstruction using massive allografts after resection of extremity osteosarcomas the study design: A retrospective cohort study". Int J Surg. 21: 108–11. doi:10.1016/j.ijsu.2015.07.686. PMID 26232712.
- ↑ Al Samaraee A, Angamuthu N, Fasih T (November 2014). "Primary breast osteosarcoma: a case report and review of literature". Scott Med J. 59 (4): e1–4. doi:10.1177/0036933014551674. PMID 25210125.