Part of the MD Anderson Cancer Care Series book series (MDCCS)

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.


National Comprehensive Cancer Network Postoperative Chemotherapy Malignant Fibrous Histiocytoma Craniofacial Bone Parosteal Osteosarcoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Readings

  1. 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.PubMedGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.Google Scholar
  5. Bertoni F, Present D, Hudson T, Enneking WF. The meaning of radiolucencies in parosteal osteosarcoma. J Bone Joint Surg Am. 1985;67:901–10.PubMedGoogle Scholar
  6. Bielack S, Jurgens H, Jundt G, et al. Osteosarcoma: the COSS experience. Cancer Treat Res 2009;152:289–308.PubMedCrossRefGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. Clark JL, Unni KK, Dahlin DC, Devine KD. Osteosarcoma of the jaw. Cancer. 1983;51:2311–6.PubMedCrossRefGoogle Scholar
  9. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A III (eds). AJCC cancer staging manual, 7th edn. Springer, New York: 2010.Google Scholar
  10. 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.PubMedGoogle Scholar
  11. Eilber F, Giuliano A, Eckardt J, et al. Adjuvant chemotherapy for osteosarcoma: a randomized prospective trial. J Clin Oncol. 1987;5:21–6.PubMedGoogle Scholar
  12. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.PubMedGoogle Scholar
  13. Fleming ID, Cooper JS, Henson DE, et al (eds). AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia: 1997.Google Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. Grimer RJ, Bielack S, Flege S, et al. Periosteal osteosarcoma—a European review of outcome. Eur J Cancer. 2005a;41:2806–11.PubMedCrossRefGoogle Scholar
  17. Grimer RJ, Sommerville S, Warnock D, et al. Management and outcome after local recurrence of osteosarcoma. Eur J Cancer. 2005b;41:578–83.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.PubMedCrossRefGoogle Scholar
  26. Longhi A, Errani C, Gonzales-Arabio D, et al. Osteosarcoma in patients older than 65 years. J Clin Oncol. 2008;26:5368–73.PubMedCrossRefGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. Okada K, Frassica FJ, Sim FH, et al. Parosteal osteosarcoma. A clinicopathological study. J Bone Joint Surg Am. 1994;76:366–78.PubMedGoogle Scholar
  32. Patel SR. Radiation-induced sarcoma. Curr Treat Options Oncol. 2000;1:258–61.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. Schajowicz F. Histological typing of bone tumors. World Health Organization international histological classification of tumors. Springer, Berlin: 1993.CrossRefGoogle Scholar
  35. Shaylor PJ, Peake D, Grimer RJ, et al. Paget’s osteosarcoma: no cure in sight. Sarcoma. 1999;3:191–2.PubMedCrossRefGoogle Scholar
  36. 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.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Orthopaedic Oncology, Unit 1448, Division of SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Sarcoma Medical Oncology, Unit 450, Division of Cancer MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations