What management is recommended for high-grade osteosarcoma?

Cancers are given different grades for categorisation that indicate the severity of the disease. A high grade disease indicates that cancergrowth is fast. For high grade osteosarcoma, the entire tumour should be removed along with tissue surrounding the tumour, ensuring that the tissue surrounding the tumour is cleared of any cancer cells. Surgery to remove all tumours that have spread to the lungs should be considered.

Chemotherapy is recommended to be given before and not after the surgery.

Methotrexate interferes with cell growth by inhibiting DNA, RNA and protein synthesis and targets cancer cells as they are actively producing DNA and RNA. Adriamycin (also known as doxorubicin) interacts with DNA and inhibits protein synthesis, hence inhibiting cancer cell growth. Cisplatin is a drug that interferes with DNA replication and hence cancer cell growth.

Methotrexate given in high doses, adriamycin (doxorubicin), and cisplatin form the backbone in most chemotherapeutic regimes for high-grade osteosarcoma, especially in children and young adults. In older adults, doxorubicin and cisplatin alone without methotrexate is a reasonable option in view of their poor tolerance to the side effects of high-dose methotrexate.

Patients with cancer that has spread to other sites in the body (mainly to the lungs) have a significantly poorer outcome. If the cancer does not respond to standard treatment, chemotherapy options include ifosfamide and etoposide given in high doses, and gemcitabine with docetaxel. Ifosfamide is an anticancer agent that damages cancer cell DNA so that cancer cells cannot grow. Etoposide is an anticancer drug that causes DNA strands to break and promotes death of cancer cells. Gemcitabine is a drug that inhibits cancer cell growth and promotes cancer cell death. Docetaxel is an anti-cancer drug that inhibits cancer cell division.