Treatments for childhood osteosarcoma

The following are treatment options for childhood osteosarcoma. The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan.

Treatment for childhood osteosarcoma may depend on:

• whether the cancer has spread
• the size and location of the tumour
• your child’s age
• your child’s overall health
• your child’s lifestyle and what they prefer or want

In localized childhood osteosarcoma, the cancer is only in the bone it started in, or in nearby tissues. It’s usually treated with chemotherapy, followed by surgery, followed by more chemotherapy.

Chemotherapy uses drugs to destroy cancer cells. It’s often given before surgery for localized childhood osteosarcoma (called neoadjuvant chemotherapy). Usually, chemotherapy is also given after surgery to destroy any cancer cells left behind and to lower the risk of cancer coming back.

The standard chemotherapy drug combination used for localized osteosarcoma is high-dose methotrexate, doxorubicin and cisplatin (MAP).

Other chemotherapy drugs used for localized osteosarcoma include:

• ifosfamide
• cyclophosphamide
• etoposide
• carboplatin

If ifosfamide or cyclophosphamide is used, then mesna is given at the same time. Mesna is a supportive drug used to protect the bladder from damage and lower the risk of urinary tract problems caused by these chemotherapy drugs.

If doxorubicin is used, then dexrazoxane is given at the same time. Dexrazoxane is used to protect the heart from damage caused by this chemotherapy drug.

Find out more about chemotherapy for childhood bone cancer.

Surgery is a standard treatment for localized osteosarcoma in children. It may be the first treatment given, or it may be offered after chemotherapy.

The main goal of surgery is to remove the whole tumour, along with some normal tissue around it (called the surgical margin). The other tissues or structures that need to be removed will depend on the size of the tumour and where it is.

The following types of surgery may be offered for localized osteosarcoma.

Wide resection removes the bone tumour and a small amount of bone and tissue around it. Doctors may use other terms for wide resection, such as en bloc resection or wide excision. Wide resection may be done for osteosarcoma in the jaw, pelvis (hip), arm or leg.

Limb-sparing surgery is often used to remove tumours in an arm or leg. During limb-sparing surgery, surgeons do a wide resection to remove the tumour without amputating the limb.

Rotationplasty is a type of surgery that can be done to remove a tumour near the knee. During rotationplasty, the tumour and knee joint are removed and the remaining ankle joint is rotated to function as a knee joint. Find out more about rotationplasty.

Amputation removes part or all of an arm or leg, along with the tumour. It may be done when it isn’t possible to do limb-sparing surgery.

Find out more about surgery for childhood bone cancer.

Metastatic childhood osteosarcoma is cancer that has spread from the bone to other parts of the body. Metastatic osteosarcoma in children is usually treated with chemotherapy, followed by surgery. Surgery is sometimes used to remove cancer that has spread to the lungs (lung metastases).

Chemotherapy uses drugs to destroy cancer cells. The most common chemotherapy drug combination used for metastatic osteosarcoma is high-dose methotrexate, doxorubicin and cisplatin (MAP).

Other chemotherapy drugs used for metastatic osteosarcoma are:

• ifosfamide
• etoposide
• cyclophosphamide
• carboplatin

Find out more about chemotherapy for childhood bone cancer.

Surgery is a standard treatment for metastatic osteosarcoma in children. It’s often done after chemotherapy.

A wide resection removes the bone tumour and a small amount of bone and tissue around it. It may be used for osteosarcoma in the jaw, pelvis (hip), arm or leg. Tumours in an arm or leg may be treated with limb-sparing surgery, amputation or rotationplasty.

If osteosarcoma spreads to the lungs, it’s called lung metastasis. Surgery may be used to treat osteosarcoma that has spread to the lungs if doctors think that the whole tumour can be removed.

Sometimes surgery is needed to relieve pain or repair a broken bone. In these cases, surgery to remove the primary tumour may be done before chemotherapy is given.

Find out more about surgery for childhood bone cancer.

Recurrent childhood osteosarcoma means that the cancer has come back after it has been treated.

The treatments offered for recurrent childhood osteosarcoma are based on:

• how long it has been since the last treatment
• your child’s age when they were first diagnosed with cancer
• if the cancer had already spread (metastasized) at that first diagnosis
• whether the recurrence is localized or has spread
• whether or not the recurrent tumour can be removed
• which treatments were used before

The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan. Your child may be offered the following treatments for recurrent osteosarcoma.

Your child may be offered surgery to remove tumours that recur in the bones or in the lungs.

Find out more about surgery for childhood bone cancer.

Chemotherapy uses drugs to destroy cancer cells. The most common chemotherapy drug used for recurrent osteosarcoma is ifosfamide, sometimes given with etoposide.

Find out more about chemotherapy for childhood bone cancer.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Your child may be offered targeted therapy as part of a clinical trial. Some targeted therapy drugs that may be used include:

• regorafenib

• cabozantinib
• everolimus
• dinutuximab

Find out more about targeted therapy.

Children with cancer may be treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

Treatment is successful for many children with cancer, but in some cases it isn’t. Advanced cancer is cancer that is unlikely to be cured. When cancer is advanced, the focus of treatment can change from curing the cancer to ensuring a good quality of life. There is help and support available. Find out more about when a cure is not possible.