Osteosarcoma is a cancer of the bone that usually affects the large bones of the arm or leg. This cancer can also be called osteogenic sarcoma. This type of cancer usually starts in osteoblasts, which are a type of bone cell that grow into new bone tissue. Osteosarcoma is most common in teenagers and young adults. It commonly forms in the ends of the long bones of the body, which include bones of the arms and legs. In children and teenagers, it often develops around the knee. Rarely, osteosarcoma may be found in soft tissue or organs in the chest or abdomen.
Osteosarcoma can be localized or metastatic. If the osteosarcoma is localized the cancer has not spread out of the bone where it started. There may be one or more areas of cancer in the bone that can be removed during surgery. Metastatic osteosarcoma has spread from the bone in which the cancer began to other parts of the body. The cancer most often spreads to the lungs, but it may also spread to other bones. Whether the cancer is localized or metastatic will determine how the osteosarcoma is treated.
Possible signs of osteosarcoma include pain and swelling over a bone or a bony part of the body. These and other symptoms may be caused by osteosarcoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
After osteosarcoma has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. The process used to find out if cancer has spread to other parts of the body is called staging. For osteosarcoma, most patients are grouped according to whether cancer is found in only one part of the body or has spread. The following tests and procedures may be used:
There are different types of treatment for patients with osteosarcoma.
Different types of treatment are available for children with osteosarcoma. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment. A link to a list of current clinical trials can be found on the National Cancer Institute website (http://www.cancer.gov).
Four types of standard treatment are used:
Surgery to remove the entire tumor will be done when possible. Chemotherapy may be given first, to make the tumor smaller so less tissue and bone needs to be removed. This is called neoadjuvant chemotherapy.
The following types of surgery may be done:
Studies have shown that survival is the same whether the first surgery done is a limb-sparing surgery or an amputation. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. The treatment given after the surgery, either chemotherapy or radiation is called adjuvant therapy. The goal of adjuvant therapy is to lower the risk that the cancer will come back.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Osteosarcoma is not killed easily by radiation therapy. This therapy may be used when a small amount of cancer is left after surgery or used together with other treatments.
Samarium is a radioactive drug that targets areas where bone cells are growing, such as tumor cells in bone. It helps relieve pain caused by cancer in the bone and it also kills blood cells in the bone marrow. Before treatment with samarium, stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After treatment with samarium is complete, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
The standard treatment options for osteosarcoma are determined based on the localized or metastatic state of the cancer.
Treatment may include the following:
When osteosarcoma spread, it usually spreads to the lung. Treatment of osteosarcoma and MFH with lung metastasis is usually chemotherapy followed by surgery to remove the cancer that has spread to the lung.
Bone Metastasis or Bone with Lung Metastasis
Osteosarcoma may spread to bone and/or the lung. Treatment may include the following:
Treatment of recurrent osteosarcoma may include the following:
FUSILEV, a folate analog, is available commercially in vials for injection as freeze-dried powder.
In 2011, Spectrum Pharmaceuticals sought multiple supply sources for FUSILEV, to offset any demand increase. Currently, Spectrum is able to meet all supply requirements.
FUSILEV is a folate analog indicated for:
Limitations of Use
• FUSILEV is not approved for pernicious anemia and megaloblastic anemias. Improper use may cause a hematologic remission while neurologic manifestations continue to progress.
Important Safety Information for FUSILEV