Is osteosarcoma sensitive to chemotherapy?

Written by Na Hong Wei
Orthopedics
Updated on September 27, 2024
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Osteosarcoma is relatively sensitive to chemotherapy. Currently, the treatment of malignant tumors is primarily a comprehensive approach centered around surgery. However, the treatment of osteosarcoma should start with neoadjuvant chemotherapy, which involves administering a certain number of chemotherapy sessions, generally around six, before surgery. After chemotherapy, the tumor itself shrinks in size, pain is reduced, and the patient's cachexia also improves. At this point, choosing an optimal surgical method based on the tumor’s location and size becomes feasible, whether it involves amputation, limb-salvage, or other treatment methods such as the implantation of prosthetics. Postoperative chemotherapy is then administered. With this approach, there is a significant improvement in the five-year survival rate. Therefore, the treatment of osteosarcoma is inseparable from chemotherapy, requiring both preoperative and postoperative chemotherapy, making osteosarcoma quite sensitive to chemotherapy overall.

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Written by Cheng Bin
Orthopedics
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Osteosarcoma is malignant.

Regarding whether osteosarcoma is benign or malignant, it is certain that osteosarcoma is a malignant tumor with a very high degree of malignancy. Once osteosarcoma is definitively diagnosed, aggressive treatment is necessary. Surgery is the main treatment approach, aiming to perform as extensive a resection as possible, or amputation may be required when necessary. After surgery, the resected specimen must be sent for pathological examination. Based on the type of pathology, the next step in treatment, either radiotherapy or chemotherapy, will be determined to minimize the recurrence of osteosarcoma, as a recurrence can endanger the patient's life.

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Written by Na Hong Wei
Orthopedics
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Osteosarcoma bone metastasis symptoms

The symptoms of osteosarcoma metastasis, osteosarcoma most commonly metastasizes to the lungs. If pulmonary metastasis occurs, there are at least two prominent characteristics. The first is that most metastatic tumors are located on the surface of the lungs and are rarely within the lung parenchyma, thus, they are not difficult to detect. The second point is that most metastatic tumors predominantly present as multiple bilateral lung metastases. Isolated unilateral lung metastasis is very rare. Therefore, this characteristic determines that osteosarcoma lung metastasis can only be managed with local wedge-shaped or segmental lung resections as the basic comfort measure. In fact, this simple surgical approach often allows for complete removal of the metastatic tumors while preserving most of the normal lung tissue.

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Written by Na Hong Wei
Orthopedics
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How is osteosarcoma diagnosed?

Currently, the diagnosis of osteosarcoma in clinical settings primarily relies on a combination of clinical symptoms, imaging studies, and pathological findings. Clinically, osteosarcomas commonly occur in the distal femur, proximal tibia, and lower end of the humerus, manifesting as localized persistent pain, nocturnal pain, and swelling, often accompanied by superficial venous engorgement and increased skin temperature. Systemic symptoms of cachexia may appear, and even pathological fractures. Imaging is indispensable, revealing osteoblastic, osteolytic, or mixed osteolytic lesions, usually with a pronounced periosteal reaction, Codman's triangle (a common sign of malignancy), or sunburst patterns. Magnetic resonance imaging (MRI) is very important for diagnosing bone tumors as it can indicate the tumor's boundaries and the extent of erosion. Additionally, PET-CT and radioactive isotope scanning are considered crucial for tumor diagnosis. Pathological examination is currently regarded as the gold standard for diagnosing osteosarcoma. This involves a biopsy, usually taking a small part of the tumor for examination from a molecular biology perspective. However, when performing a biopsy, it is important to note two things: first, it is preferable to take the biopsy intraoperatively; second, if there is no plan for systematic treatment of osteosarcoma, it is best not to proceed with a biopsy to avoid potentially accelerating the spread or even hastening metastasis. Therefore, the diagnosis of osteosarcoma must be approached with caution, requiring a combination of clinical symptoms, necessary auxiliary examinations, and pathological analysis.

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Written by Guan Yu Hua
Orthopedic Surgery
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Characteristics of Osteosarcoma

Osteosarcoma is a malignant tumor of the bone that primarily occurs in adolescents and young adults, commonly found at the metaphyseal ends of long bones. For example, it may occur at the distal end of the tibia, the distal end of the femur, or the metaphyseal end of the humerus. Clinically, the main symptom is pain, which is persistent and more noticeable at night, accompanied by a local mass, limited movement, increased local skin temperature, distended veins, and general symptoms such as weight loss and even cachexia. Some patients may experience pathological fractures. Often, there are no symptoms in the early stages, and by the time it is detected, it is usually in an intermediate or advanced stage. Radiographic examination typically shows a Codman's triangle or sunburst pattern. Early detection and treatment are crucial. The usual treatment choice is surgical, such as deactivation and reimplantation, or limb-salvage surgery with prosthetic implantation. Additionally, amputation followed by extensive chemotherapy is another option. With recent advances in chemotherapy, there has been significant improvement in life extension.

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Written by Na Hong Wei
Orthopedics
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Is there a cure for osteosarcoma?

Osteosarcoma is treatable, but it requires proper medical treatment. Currently, adjuvant chemotherapy significantly improves the five-year survival rate for osteosarcoma. The main treatment approach is still surgery as part of a comprehensive therapy. Specifically, the first step involves adequate preoperative chemotherapy, generally no fewer than six sessions over about eight weeks, or approximately two months. After this, patients often experience reduced pain, weight gain, improved positioning of the tumor, and a decrease in tumor size. Depending on the specific situation, a decision is made on the type of surgery to be performed—whether to amputate, preserve the limb, install a prosthetic, or use artificial bone as a replacement. Postoperative chemotherapy is usually also required to help ensure that the tumor does not recur and to increase the five-year or ten-year survival rate. Therefore, the current five-year survival rate for osteosarcoma has increased from the previous 40%-50% to about 80%. So, as long as one chooses the right hospital and the right treatment plan, and maintains confidence, osteosarcoma is usually treatable.