Osteosarcoma is the most common type of bone cancer in children and young adults. It usually occurs in the long bones, such as the arms or legs, though it can also occur in the pelvis, spine, jaw or other locations in the body.
How Dana-Farber/Boston Children's approaches osteosarcoma in children
Dana-Farber/Boston Children's Cancer and Blood Disorders Center provides comprehensive medical and surgical care for children and adolescents with bone tumors, such as osteosarcoma. Our multidisciplinary approach through our Bone and Soft Tissue Program ensures in-depth discussion of each case and personalized treatment plans for every patient. We integrate expertise from pediatric oncologists, oncologic orthopedists, pediatric specialists, psychologists, social workers, and oncologic surgeons.
Treatments for osteosarcoma in children
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.
Depending on the size and location of the tumor and whether the tumor has spread, your child may receive one of the surgical treatments necessary to combat it including limb salvage surgery, amputation, or a rotationplasty. 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. 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 an injection into the muscle or fat tissue, directly to the bloodstream, or with a needle directly into the fluid surrounding the spine.
Rehabilitation and supportive care
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.
Osteosarcoma research and clinical trials
Dana-Farber/Boston Children's Cancer and Blood Disorders Center was one of the first centers in the United States to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma.
Apart from our very active basic research program on osteosarcoma and phase I and phase II clinical trials at Dana-Farber/Boston Children's, we also have available all Children's Oncology Group clinical trials for newly diagnosed, non-metastatic and metastatic osteosarcoma.
We also are conducting numerous research studies to help better understand and treat osteosarcoma. These researchers are directing and participating in national and international clinical trials to develop new treatments for patients with newly diagnosed osteosarcoma or relapsed disease, using surgery, radiation therapy and chemotherapy to more effectively overcome cancer.
For many children with rare or hard-to-treat conditions, clinical trials provide new options.
Learn more about osteosarcoma on the Dana-Farber/Boston Children's website.
Osteosarcoma occurs predominantly in adolescents and young adults.
Review of data from the Surveillance, Epidemiology and End Results program of the NCI resulted in an estimate of 4.4 per million new cases of osteosarcoma each year in people aged 0 to 24 years. The U.S. Census Bureau estimates that there will be 110 million people in this age range in 2010, resulting in an incidence of roughly 450 cases per year in children and young adults less than 25 years old. Osteosarcoma accounts for approximately 5% of childhood tumors. In children and adolescents, more than 50% of these tumors arise from the bones around the knee.
Osteosarcoma can rarely be observed in soft tissue or visceral organs. There appears to be no difference in presenting symptoms, tumor location, and outcome for younger patients (<10 years) compared with adolescents.
Two trials conducted in the 1980s were designed to address the natural history of surgically treated localized, resectable osteosarcoma of the extremity. The outcome of patients in these trials who were treated with surgical removal of the primary tumor recapitulated the historical experience before 1970; more than half of these patients developed metastases within 6 months of diagnosis, and overall, approximately 90% developed recurrent disease within 2 years of diagnosis.
Overall survival for patients treated with surgery alone was statistically inferior. The natural history of osteosarcoma has not changed over time, and fewer than 20% of patients with localized resectable primary tumors treated with surgery alone can be expected to survive free of relapse.