CORR Insights(®): Should High-grade Extraosseous Osteosarcoma Be Treated With Multimodality Therapy Like Other Soft Tissue Sarcomas?

Abstract

O rthopaedic oncology is a specialty defined by uncertainty. Although we are able to diagnose sarcoma subtypes reliably and recommend treatment plans, the reality is that even tumors with the same name can act dramatically differently. Therefore, the clinician must use many details about the individual scenario—grade, histologic subtype, size, depth, location, stage, and patient demographics—to make a logical guess as to the anticipated behavior of the diagnosed condition. As described by Fan and colleagues [3], extraosseous osteosarcoma is a representative example of a common dilemma in orthopaedic oncology: How do we select the most appropriate management strategy when we are unable to accurately predict the natural history or response to treatment in a rare cancer? The first attempt at understanding a rare tumor is by a simple descriptive case report or case series to reveal general observations about the patients in which the tumor occurs, the common features of presentation, the treatments attempted, and the observations on oncologic outcomes (survival and recurrence). The current study is the most recent in a line of such case series. In attempt to view this problem from a novel perspective, Fan and colleagues question if extraosseous osteosarcoma behaves more similarly to a soft tissue sarcoma than a skeletal osteosarcoma. This is a reasonable approach, and has worked well for most subtypes of highgrade soft tissue sarcoma as their biologic aggressiveness, response to treatment, and patient outcomes are similar. They found that some features, such as a therapeutic response to radiation, are more characteristic of soft tissue sarcoma than skeletal osteosarcoma. As the authors note, the heterogeneity of treatment increases the difficulty in interpretation, as there was This CORR Insights is a commentary on the article ‘‘Should High-grade Extraosseous Osteosarcoma Be Treated With Multimodality TherapyLikeOther Soft Tissue Sarcomas?’’ by Fan and colleagues available at: DOI: 10.1007/s11999-015-4463-y. The author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors andClinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of thewriters, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. This CORR Insights comment refers to the article available at DOI: 10.1007/s11999-0154463-y. B. J. Miller MD, MS (&) Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr, 01015 JPP, Iowa City, IA 52242, USA e-mail: benjamin-j-miller@uiowa.edu CORR Insights Published online: 27 August 2015 The Association of Bone and Joint Surgeons1 2015