Chapter Overview
The treatment of osteosarcoma forms the basis of therapy for most other sarcomas. The concepts that were developed originally for the staging, pathologic analysis, chemotherapy, and surgical management of osteosarcoma have now been applied to many other diseases. Most cases of osteosarcoma are classified as conventional osteosarcoma, which is a high-grade tumor arising typically in an adolescent patient or young adult. For these patients, the standard treatment consists of preoperative chemotherapy, wide surgical excision, careful pathologic mapping of the resected tumor, and postoperative chemotherapy based upon the percentage of necrosis of the tumor. There are many uncommon variants of osteosarcoma that behave differently than conventional osteosarcoma. Osteosarcoma of the craniofacial bones resembles conventional osteosarcoma histologically, but its prognosis is different since metastasis is uncommon. Other variants discussed in this chapter have distinctive radiographic, histologic, or demographic characteristics. Secondary osteosarcoma, which arises in a preexisting bone lesion, has a markedly worse prognosis than other forms of osteosarcoma.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Suggested Readings
Bacci G, Picci P, Avella M, et al. Effect of intra-arterial versus intravenous cisplatin in addition to systemic adriamycin and high-dose methotrexate on histologic tumor response of osteosarcoma of the extremities. J Chemother. 1992;4:189–95.
Bacci G, Ferrari S, Mercuri M, et al. Neoadjuvant chemotherapy for extremity osteosarcoma–preliminary results of the Rizzoli’s 4th study. Acta Oncol. 1998;37:41–8.
Benjamin RS, Chawla SP, Carrasco CH, et al. Preoperative chemotherapy for osteosarcoma with intravenous adriamycin and intra-arterial cis-platinum. Ann Oncol. 1992;3(Suppl 2):S3–6.
Benjamin RS, Patel SR, Armen T, et al. The value of ifosfamide in postoperative neoadjuvant chemotherapy of osteosarcoma [meeting abstract]. Proc Annu Meet Am Soc Clin Oncol. 1995;14:A1690.
Bertoni F, Present D, Hudson T, Enneking WF. The meaning of radiolucencies in parosteal osteosarcoma. J Bone Joint Surg Am. 1985;67:901–10.
Bielack S, Jurgens H, Jundt G, et al. Osteosarcoma: the COSS experience. Cancer Treat Res 2009;152:289–308.
Chou AJ, Kleinerman ES, Krailo MD, et al. Addition of muramyl tripeptide to chemotherapy for patients with newly diagnosed metastatic osteosarcoma: a report from the Children’s Oncology Group. Cancer. 2009;115:5339–48.
Clark JL, Unni KK, Dahlin DC, Devine KD. Osteosarcoma of the jaw. Cancer. 1983;51:2311–6.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III (eds). AJCC cancer staging manual, 7th edn. Springer, New York: 2010.
Edmonson JH, Green SJ, Ivins JC, et al. A controlled pilot study of high-dose methotrexate as postsurgical adjuvant treatment for primary osteosarcoma. J Clin Oncol. 1984;2:152–6.
Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21–6.
Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.
Fleming ID, Cooper JS, Henson DE, et al (eds). AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia: 1997.
Frassica FJ, Sim FH, Frassica DA, Wold LE. Survival and management considerations in postirradiation osteosarcoma and Paget’s osteosarcoma. Clin Orthop Relat Res. 1991;270:120–7.
Gorlick R, Anderson P, Andrulis I, et al. Biology of childhood osteogenic sarcoma and potential targets for therapeutic development: meeting summary. Clin Cancer Res. 2003;9:5442–53.
Grimer RJ, Bielack S, Flege S, et al. Periosteal osteosarcoma—a European review of outcome. Eur J Cancer. 2005a;41:2806–11.
Grimer RJ, Sommerville S, Warnock D, et al. Management and outcome after local recurrence of osteosarcoma. Eur J Cancer. 2005b;41:578–83.
Harting MT, Blakely ML, Jaffe N, et al. Long-term survival after aggressive resection of pulmonary metastases among children and adolescents with osteosarcoma. J Pediatr Surg. 2005b;41:194–9.
Jaffe N, Knapp J, Chuang VP, et al. Osteosarcoma: intra-arterial treatment of the primary tumor with cis-diamminedichloroplatinum II (CDP). Angiographic, pathologic, and pharmacologic studies. Cancer. 1983;51:402–7.
Jaffe N, Raymond AK, Ayala A, et al. Effect of cumulative courses of intraarterial cis-diamminedichloroplatinum-II on the primary tumor in osteosarcoma. Cancer. 1989;63:63–7.
Jaffe N, Patel SR, Benjamin RS. Chemotherapy in osteosarcoma. Basis for application and antagonism to implementation; early controversies surrounding its implementation. Hematol Oncol Clin North Am. 1995;9:825–40.
Jaffe N, Carrasco H, Raymond K, Ayala A, Eftekhari F. Can cure in patients with osteosarcoma be achieved exclusively with chemotherapy and abrogation of surgery? Cancer. 2002;95:2202–10.
Kleinerman ES, Jia SF, Griffin J, et al. Phase II study of liposomal muramyl tripeptide in osteosarcoma: the cytokine cascade and monocyte activation following administration. J Clin Oncol. 1992;10:1310–6.
Le Deley MC, Guinebretiere JM, Gentet JC, et al. SFOP OS94: a randomised trial comparing preoperative high-dose methotrexate plus doxorubicin to high-dose methotrexate plus etoposide and ifosfamide in osteosarcoma patients. Eur J Cancer. 2007;43:752–61.
Link MP, Goorin AM, Miser AW, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314:1600–6.
Longhi A, Errani C, Gonzales-Arabio D, et al. Osteosarcoma in patients older than 65 years. J Clin Oncol. 2008;26:5368–73.
Meyers PA, Heller G, Healey J, et al. Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol. 1992;10:5–15.
Meyers PA, Gorlick R, Heller G, et al. Intensification of preoperative chemotherapy for osteogenic sarcoma: results of the Memorial Sloan-Kettering (T12) protocol. J Clin Oncol. 1998;16:2452–8.
Meyers PA, Schwartz CL, Krailo MD, et al. Osteosarcoma: the addition of muramyl tripeptide to chemotherapy improves overall survival—a report from the Children’s Oncology Group. J Clin Oncol. 2008;26:633–8.
Nathan SS, Gorlick R, Bukata S, et al. Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis. Cancer. 2006;107:1607–16.
Okada K, Frassica FJ, Sim FH, et al. Parosteal osteosarcoma. A clinicopathological study. J Bone Joint Surg Am. 1994;76:366–78.
Patel SR. Radiation-induced sarcoma. Curr Treat Options Oncol. 2000;1:258–61.
Patel SR, Papadopolous N, Raymond AK, et al. A phase II study of cisplatin, doxorubicin, and ifosfamide with peripheral blood stem cell support in patients with skeletal osteosarcoma and variant bone tumors with a poor prognosis. Cancer. 2004;101:156–63.
Schajowicz F. Histological typing of bone tumors. World Health Organization international histological classification of tumors. Springer, Berlin: 1993.
Shaylor PJ, Peake D, Grimer RJ, et al. Paget’s osteosarcoma: no cure in sight. Sarcoma. 1999;3:191–2.
Smeele LE, Kostense PJ, van der Waal I, Snow GB. Effect of chemotherapy on survival of craniofacial osteosarcoma: a systematic review of 201 patients. J Clin Oncol. 1997;15:363–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Lin, P.P., Patel, S. (2013). Osteosarcoma. In: Lin, P., Patel, S. (eds) Bone Sarcoma. MD Anderson Cancer Care Series. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-5194-5_5
Download citation
DOI: https://doi.org/10.1007/978-1-4614-5194-5_5
Published:
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4614-5193-8
Online ISBN: 978-1-4614-5194-5
eBook Packages: MedicineMedicine (R0)