MUSCULOSKELETAL TUMORS
HOME > MUSCULOSKELETAL TUMORS > MALIGNANT BONE TUMORS

OSTEOSARCOMA

Osteosarcoma is a rare neoplasm that develops in bone tissue. Our osteosarcoma patients receive efficient, coordinated treatment from a multidisciplinary team of specialists that include pediatric oncologists, medical oncologists, pediatric surgeons, radiation oncologists, orthopedic oncologists, vascular surgeons and rehabilitation experts. Osteosarcoma tumors are often found when an individual experiences pain or swelling in a bone or joint that does not go away completely. For suspected cases of osteosarcoma, physicians evaluate the tumor using imaging studies such as X-rays, CT and MRI scans, and bone scans. To diagnose osteosarcoma, the doctor must remove a small sample of the suspected tumor for examination by a pathologist (biopsy). The pathologist views the sample under a microscope to determine whether the tumor is malignant and to identify the exact type. After completing a thorough evaluation of the patient, the patient care team develops an individualized treatment strategy.

The treatment of osteosarcoma depends upon the location and size of the tumor and the needs of the patient. Osteosarcoma treatment has two goals: to cure the tumor and preserve as much function as possible.

Chemotherapy: A person with osteosarcoma generally receives a combination of cancer-fighting drugs (chemotherapy) followed by surgery on the tumor. Chemotherapy is given to control the spread of the disease and to shrink the tumor, making surgery more manageable.

Surgery: In about 90 percent of osteosarcoma cases of the arm or leg, the limb can be saved. The decision to try to save the limb depends upon the tumor's size, its proximity to adjacent structures and the response to chemotherapy given before surgery.

Limb Salvage Techniques: Limb-salvage techniques include rotationplasty, bone grafts (autografts and allografts) and implantation of prosthetic joints. Autograft: In this procedure, a surgeon harvests the patient's own bone tissue to implant at the site where tumor is removed. One common technique is called free vascularized fibular grafting. Surgeons harvest the smaller of the two lower leg bones as well as its blood vessels to implant at the cancer site. We have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) techniques include a greater chance for the bone to heal and a reduced chance for infection. Allograft: Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas after resection of the osteosarcoma tumor. This is called allograft. We have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system. Rotationplasty: Typically used for young or athletic patients who have osteosarcoma near the knee joint, rotationplasty can allow a patient to run or walk with near-normal function. An orthopedic surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle becomes the "knee." Specialists then fit the patient with a prosthetic ankle and foot. Prosthetic Implants: Surgeons can replace sections of bone with specialized prosthetic implants. Many different sizes of expandable and solid implants are available. Surgeons consider whether the patient will experience further bone growth before recommending prosthetic implants.

Postoperative Chemotherapy: Following surgery, additional chemotherapy is often recommended to improve the chances that the cancer cells have been eliminated. This chemotherapy course may last eight to 12 months. In general, radiation is used only in osteosarcoma cases where surgery is impossible, unacceptable to the patient or impractical because of the tumor's location or other factors.

Advanced Cases: For individuals whose cancer has spread, treatment is more difficult and depends on tumor location. Osteosarcoma metastases occur more often in the lung than at other sites. Physicians develop individualized treatment programs to control cancer and obtain long-term remission. These approaches may include surgery, radiation and treatments under investigation in clinical trials.  Patients with osteosarcoma lung metastases are usually treated with lung surgery, if possible.

CHONDROSARCOMA

Our chondrosarcoma patients receive treatment from a multidisciplinary team that includes orthopedic oncologists (orthopedic surgeons specialize in bone and soft tissue tumors), plastic surgeons, vascular surgeons, rehabilitation experts, medical and radiation oncologists, and a diverse group of allied health professionals. X-rays and other imaging techniques such as a computed tomography (CT) or magnetic resonance imaging (MRI) are used to identify the tumor. To diagnose chondrosarcoma, the doctor removes a small sample of the suspected tumor in a procedure known as a biopsy. A pathologist looks at the sample under a microscope to determine whether the tissue contains malignant cells. A chest CT and a bone scan help the physician evaluate the lungs and other areas where the cancer may have spread (metastasized).

The treatment for chondrosarcoma has two goals: to cure the tumor and to preserve as much function as possible. Surgery is the main treatment option for chondrosarcoma. Surgical options depend upon the tumor's size, and whether the tumor has grown into or around nerves, blood vessels or a joint. If specialists treat the cancer before it spreads (metastasizes) to other locations in the body, the cure rate is high. For individuals whose cancer has spread, treatment is more difficult and depends on the location of the disease. In certain cases chemotherapy may be recommended. For patients who have local recurrence with no evidence of metastasis, surgery plus radiation may be recommended (preoperative external beam radiation, surgery, intraoperative radiation).

Limb Salvage Techniques: Limb salvage techniques include bone grafts (autografts and allografts) and prosthetic (artificial) implants.  Autograft: In this procedure a surgeon harvests the patient's own bone tissue from a healthy bone to implant at the site where tumor is removed. One common form of this procedure is called free vascularized fibular grafting. In this procedure surgeons harvest the smaller of the two lower leg bones, as well as its blood vessels to implant at the cancer site. We have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) techniques include a greater chance for the bone to heal and a reduced chance for infection. Allograft: Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank or donor to rebuild areas where a chondrosarcoma tumor is removed. This process is called an allograft procedure. We have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system.  Prosthetic Implants: Surgeons can replace sections of bone with specialized prosthetic implants. Expandable and solid implants of many different sizes are available. This may be a viable option for some chondrosarcoma patients.

EWING'S SARCOMA

Our multidisciplinary team of experts who provide medical care for Ewing sarcoma patients includes pediatric oncologists, medical oncologists, orthopedic oncologists (orthopedic surgeons who specialize in bone and soft tissue tumors), pediatric surgeons, radiation oncologists, plastic surgeons, vascular surgeons and rehabilitation experts.

DIAGNOSIS: The first sign of Ewing sarcoma may be pain in a bone or joint. The individual may think the pain and swelling comes from a sports injury or sprain. However, a doctor should evaluate the symptoms when pain does not go away in a reasonable amount of time. Evaluation of the patient begins with imaging studies, such as X-ray, ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI), to locate the suspected tumor. Other imaging techniques that may be used include a chest CT, a bone scan and positron emission tomography (PET) scan. These images are helpful in evaluating the lungs and bones, areas to which the cancer commonly spreads (metastasizes). To diagnose Ewing's sarcoma, the doctor removes small samples of the suspected tumor for examination (biopsy). A pathologist looks at the cells under a microscope to determine whether the tissue contains malignant cells. In some cases, tumor cells are tested for chromosome abnormalities. A bone marrow biopsy may also be needed to help doctors determine the extent of the disease.

The treatment of patients with Ewing sarcoma includes a combination of cancer-fighting drugs (chemotherapy) and surgery or radiation. The treatment plan has two main goals: (1) to cure the cancer, and (2) to save as much function of the affected area as possible. Patients with Ewing sarcoma receive a combination of cancer-fighting drugs (chemotherapy) and surgery or radiation. Oncologists prescribe chemotherapy to control the spread of the disease to other bones or locations in the body and to shrink the tumor. Surgery or radiation typically is scheduled two to four months after chemotherapy begins. The decision to use radiation, surgery or both can be difficult, and the choice varies among patients. Following surgery or radiation, physicians typically recommend additional chemotherapy to eliminate any remaining cancer cells.  In about 80 percent of Ewing sarcoma cases involving an arm or leg, the limb can be saved. We have significant experience in limb-saving techniques, including bone grafts, rotationplasty and prosthetic implants.

Limb Salvage Techniques: The possibility of saving the limb depends on the tumor's size and location; whether it has grown into or around a joint, nerves, or blood vessels; and its response to chemotherapy.Options include rotationplasty, bone grafts (autografts and allografts) and prosthetic implants. Autograft: In this procedure a surgeon harvests the patient's own bone tissue to implant at the site where Ewing's sarcoma tumor is removed. One common form of this procedure is called free vascularized fibular grafting. In this procedure surgeons harvest the smaller of the two lower leg bones and its blood vessels to implant at the cancer site. We have used the fibula to replace the upper leg bone, the upper arm bone, the lower leg bone and the jaw. Benefits of this procedure over allograft (bone graft from a donor) include a greater chance for the bone to heal and a reduced chance for infection. Allograft: Orthopedic oncologists can use bone, tendons and ligaments from a tissue bank to rebuild areas where the Ewing sarcoma tumor is removed. This procedure is called an allograft. We have significant experience using the procedure to replace joints (osteoarticular allograft) or other portions of the musculoskeletal system. Rotationplasty: This procedure is typically used for young or athletic patients who have Ewing sarcoma near the knee joint. Rotationplasty can allow a patient to run or walk with near-normal function. During the procedure, an orthopedic surgeon removes the tumor by cutting above and below the knee. The lower portion of the leg is rotated and reattached so that the ankle "becomes" the knee. Specialists then fit the patient with a prosthetic ankle and foot. Prosthetic Implants: Surgeons can replace sections of bone with specialized prosthetic implants. Expandable and solid implants of many different sizes are available. Surgeons consider whether the patient will experience further bone growth before recommending prosthetic implants.

 

 

Read more on treatment (pdf): Primary Bone Sarcomas Treatment Guidelines