Treatment Option Overview
There are different types of treatment for children with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS).
You and your child's care team will work together to decide treatment. Many factors will be considered, such as where the cancer is located and your child's age and overall health.
Your child's treatment plan will include information about the tumor, the goals of treatment, treatment options, and the possible side effects. It will be helpful to talk with your child's care team before treatment begins about what to expect. For help every step of the way, visit our booklet, Children with Cancer: A Guide for Parents.
Children with osteosarcoma or UPS should have their treatment planned by a team of health care providers who are experts in treating cancer in children.
A pediatric oncologist, a doctor who specializes in treating children with cancer, oversees treatment of osteosarcoma. The pediatric oncologist works with other health care providers who are experts in treating osteosarcoma and UPS and who specialize in certain areas of medicine. Other specialists may include:
- pediatrician
- orthopedic surgeon who has experience treating bone tumors
- radiation oncologist
- rehabilitation specialist
- pediatric nurse specialist
- social worker
- child-life specialist
- psychologist
- fertility specialist
The following types of treatment are used:
Surgery
Surgery to remove the entire tumor will be done when possible. Chemotherapy may be given before surgery to make the tumor smaller. This is called neoadjuvant chemotherapy. Chemotherapy is given so less bone tissue needs to be removed and there are fewer problems after surgery.
The following types of surgery may be done:
- Wide local excision removes the cancer and some healthy tissue around it.
- Limb-sparing surgery removes a tumor in an arm or leg without amputation. Limb-sparing surgery is often an option for children with osteosarcoma in an arm or leg. The tumor is removed by wide local excision. The removed tissue and bone may be replaced with a graft using tissue and bone taken from another part of the body, or with an implant such as artificial bone. If a fracture is found at the time of diagnosis or during chemotherapy before surgery, limb-sparing surgery may still be possible in some cases. If the surgeon is not able to remove all of the tumor and enough healthy tissue around it, an amputation may be done.
- Amputation removes part or all of an arm or leg. This may be done when it is not possible to remove all of the tumor in limb-sparing surgery. If prosthesis is part of the plan, fitting and training will take place with a prosthetist (a specialist in artificial limbs) over several weeks to months.
- Rotationplasty removes the tumor and the knee joint. The part of the leg that remains below the knee is then attached to the part of the leg that remains above the knee, with the foot facing backward and the ankle acting as a knee. A prosthesis may then be attached to the foot.
Studies have shown that survival is the same whether the first surgery done is a limb-sparing surgery or an amputation.
After the doctor removes all the cancer that can be seen at the time of the surgery, chemotherapy is given to kill any cancer cells that are left. Treatment given after the surgery to lower the risk that the cancer will come back is called adjuvant therapy.
Chemotherapy
Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells. Chemotherapy either kills the cancer cells or stops them from dividing. Chemotherapy may be given alone or with other types of treatment.
Chemotherapy for osteosarcoma and UPS is injected into a vein. When given this way, the drugs enter the bloodstream and can reach cancer cells throughout the body. Chemotherapy is usually given before and after surgery to remove the tumor.
Chemotherapy drugs used alone or in combination to treat osteosarcoma include:
- carboplatin
- cisplatin
- cyclophosphamide
- docetaxel
- doxorubicin
- etoposide
- gemcitabine
- ifosfamide
- methotrexate
Other chemotherapy drugs not listed here may also be used.
Learn more about how chemotherapy works, how it is given, common side effects, and more at Chemotherapy to Treat Cancer.
Radiation therapy
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Osteosarcoma is treated with external beam radiation therapy. This type of therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
Osteosarcoma and UPS cells are not killed easily by external radiation therapy. It may be used when a small amount of cancer is left after surgery, used together with other treatments, or used as palliative therapy to relieve symptoms caused by the tumor in the bone.
Samarium
Samarium is a radioactive drug that targets tumor cells in a bone. It helps relieve pain caused by cancer in the bone and it also kills blood cells in the bone marrow. It is used to treat osteosarcoma that has come back in a different bone after treatment.
Treatment with samarium may be followed by stem cell transplant. Before treatment with samarium, stem cells (immature blood cells) are removed from the child's blood or bone marrow and are frozen and stored. After treatment with samarium is complete, the stored stem cells are thawed and given back to the child through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
You may want to think about your child taking part in a clinical trial.
For some children, joining a clinical trial may be an option. There are different types of clinical trials for childhood cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.
You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your child's age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.
Treatment for osteosarcoma or UPS may cause side effects.
Cancer treatments can cause side effects. Which side effects your child might have depends on the type of treatment they receive, the dose, and how their body reacts. Talk with your child's treatment team about which side effects to look for and ways to manage them.
To learn more about side effects that begin during treatment for cancer, visit Side Effects.
Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:
- physical problems, such as infertility
- changes in mood, feelings, thinking, learning, or memory
- second cancers (new types of cancer), such as breast cancer or acute myeloid leukemia
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. Learn more about Late Effects of Treatment for Childhood Cancer.
Follow-up care may be needed.
As your child goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back).