Treatments for osteosarcoma

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

Surgery is the main treatment for osteosarcoma. It may be the first treatment 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 where the cancer has spread.

The following types of surgery may be offered for 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. It may be used for osteosarcoma in the jaw, the pelvis (hip), an arm or a leg.

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

Reconstructive surgery is done at the same time as surgery to remove the tumour. Bone and tissue grafts may be used to replace tissues removed during surgery. A joint removed with surgery may be replaced with a metallic artificial joint (endoprosthesis).

Amputation removes all or part of the arm or leg with the tumour. It may be done if a osteosarcoma has grown into the nerves or blood vessels or if the tumour is very big. Amputation may also be done if the cancer comes back (recurs) in the same area after limb-sparing surgery. Most people who have an amputation will use an artificial limb (prosthesis) after surgery.

If bone cancer spreads to the lungs, it is called lung metastasis. Surgery may be used to treat osteosarcoma that has spread to the lungs if doctors think that all of the tumour can be removed.

Surgeons will often do a wedge resection to remove the tumour along with a triangle-shaped piece of the lung around it. It’s usually done at the same time as surgery to remove the primary bone tumour.

Surgery may be done again to remove lung tumours that come back, depending on the size of the tumours and where they are.

Find out more about surgery for bone cancer.

Chemotherapy uses drugs to destroy cancer cells. It is almost always offered for high-grade osteosarcoma.

Chemotherapy is commonly used before surgery to destroy cancer cells (called neoadjuvant chemotherapy). It is also given after surgery to destroy any cancer cells that may have been left behind and reduce the risk that the cancer will come back (called adjuvant chemotherapy).

For young adults, the standard chemotherapy drug combination used for osteosarcoma includes high-dose methotrexate, doxorubicin and cisplatin (MAP). Chemotherapy combinations that use high-dose methotrexate are not usually offered for adults who are 40 or older. This is because older adults are more likely to experience serious side effects. If you are over 40, your healthcare team may try MAP with a lower dosage of methotrexate.

Other common chemotherapy drug combinations are:

• ifosfamide, sometimes with etoposide
• carboplatin, ifosfamide and doxorubicin

If an osteosarcoma does not respond to drugs used in earlier treatments or if it comes back, the following drug combinations may be used:

• ifosfamide and etoposide
• cyclophosphamide and etoposide
• gemcitabine and docetaxel

Find out more about chemotherapy for bone cancer.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is not often used for osteosarcoma.

External radiation therapy may be used to:

• treat osteosarcoma that can’t be removed with surgery
• destroy any cancer cells left behind after surgery
• relieve pain and control the symptoms of osteosarcoma that has spread (metastasized) or recurred (called palliative therapy)

Find out more about radiation therapy for bone cancer.

Talk to your doctor about clinical trials open to people with bone cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.