Osteosarcoma: Time to move on?

Abstract

Osteosarcoma treatment follows very simple rules: if you want a cure, cut out all detectable tumour and poison invisible tumour cells with as much chemotherapy as the patient can tolerate. In this age of translational research and molecularly targeted therapies, such an archaic approach may seem anachronistic. However, in contrast to any subsequent development, the combination of multidrug chemotherapy and surgery has a strong history of being highly effective: longterm survival is being achieved in some two thirds of patients with localised extremity primaries and a quarter to a third of patients with axial primaries or primary metastases. Leave out chemotherapy, and very few patients will be able to escape metastatic recurrence. Leave out surgery, and local failure is almost inevitable. Against this background, recent years have witnessed considerable progress in imaging, revolutionised by magnetic resonance techniques, and supportive care. Maybe most importantly, there has been a major shift away from mutilating amputations. Limb-salvage surgery, which used to be reserved for few and particularly favourable situations, has now become the treatment of choice for most patients in most situations. Innovative endoprosthetic devices allow the reconstruction of extremity defects even in young children who can retain considerable growth potential. Radiotherapy may play a role in selected situations not amenable to surgery.