Osteosarcoma is the most common type of bone cancer among children, adolescents and young adults. It usually occurs in the long bones of the arms or legs, but it can also occur in the pelvis and spine or, in rare cases, the jaw or other locations in the body.
Dana-Farber/Boston Children’s provides comprehensive medical and surgical care for children and adolescents with bone tumors, such as osteosarcoma. Our multidisciplinary approach through our Bone and Soft Tissue Program ensures in-depth discussion of each case and personalized treatment plans for every patient. Continue reading to learn more about osteosarcoma, or visit the Bone and Soft Tissue Program homepage to learn about our expertise and treatment options for this condition.
Osteosarcoma is the most common type of bone cancer among children, adolescents and young adults. It usually begins in the marrow cavity of the long bones, such as the arms and legs. It also can occur in the pelvis and spine, and in rare cases, in the jaw or other locations in the body.
While osteosarcoma occurs most commonly in teenagers, when the rate of bone growth is the fastest, it can affect young children and adults as well. There are about 600 new cases of osteosarcoma diagnosed each year in the United States.
Types of osteosarcoma
Some types of osteosarcoma can start just outside or at the surface of the bone, instead of in the marrow cavity. These include:
Osteosarcoma cancer cells can spread (metastasize) to other areas of the body. If this happens, it most often spreads to the lungs. It also can spread to other bones, and much less commonly, to the kidneys, the adrenal gland, the brain and the heart.
In most cases, there is no clear cause for osteosarcoma. Genetics, abnormal bone metabolism or environmental exposures play an important role in some people.
The symptoms of osteosarcoma can vary depending on the size and location of the tumor and whether it has spread. Often, an injury brings your child into a medical facility, where an x-ray may indicate suspicious bone lesions. Usually, your child does not appear to be ill. While each child may experience symptoms differently, the most common include:
Keep in mind that the symptoms of osteosarcoma may resemble other, more common conditions or medical problems, so if you suspect that your child has osteosarcoma, always consult your child's physician for a diagnosis.
Diagnostic procedures for osteosarcoma are used to determine the exact type of tumor your child has and whether the tumor has spread. Your child’s doctor will perform a complete medical and physical examination. In addition, your child’s physician may order some of the following diagnostic tests for osteosarcoma:
Treatments for osteocarcoma may involve a combination of therapies including surgery, radiation and/or chemotherapy. In most cases, children receive chemotherapy before surgery (neoadjuvant), a surgical procedure to remove the tumor and additional chemotherapy after surgery (adjuvant). Treatment options will vary greatly, depending on your child's situation. Your child's doctor and other members of your care team will discuss the options with you in-depth. Prompt medical attention and aggressive therapy are important for the best prognosis.
Children with osteosarcoma are treated through the Bone and Soft Tissue Program at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center.
Surgery for Osteosarcoma
Depending on the size and location of the tumor and whether the tumor has spread, your child may receive one of the following surgical treatments:
Surgery at Dana-Farber/Boston Children’s is personalized to help your child achieve the best functional and cosmetic outcome and to allow them to remain active and healthy. Depending on the type of surgery your child receives, your child may have to avoid certain physical activities following treatment. Limb-salvage surgery can leave an arm or leg fragile and increase the risk of fracture. As a result, patients will need to avoid high-stress physical activities, such as skiing, skate-boarding or bike riding.
Limb-salvage surgery and rotationplasty are complex procedures that require specialized expertise. Our bone tumor surgeons among the few orthopedic surgeons in the nation trained in
pediatric tumor surgery and who have experience in these procedures. At Dana-Farber/Boston Children's, we also
have physicial therapists and prostheticians who specialize in helping children who undergo these
Children who require partial or complete limb amputations will be fitted with a prosthesis and need to undergo physical therapy to adapt to using it.
Talk to your child’s pediatric oncologist or orthopedic surgeon for more information on these procedures.
If the osteosarcoma has spread to other parts of the body, such as the lungs, additional surgery may be required, and our oncologic surgeons will remove any metastases that may have formed.
Chemotherapy for Osteosarcoma
Chemotherapy is a group of drugs that interfere with the cancer cell’s ability to grow or reproduce.
While chemotherapy can be quite effective in treating certain cancers, the drugs cannot tell the difference between normal healthy cells and cancer cells. Because of this, your child may experience adverse side effects during treatment. Understanding these side effects can help you, your child and your care team prepare for, and, in some cases, prevent these symptoms from occurring.
Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. Chemotherapy can be given:
Rehabilitation is an extremely important part of your child’s osteosarcoma care. This includes physical and occupational therapy, as well as help adapting to social situations. Your child’s physician will discuss what types of lifestyle changes may be necessary, and our experienced physical and occupational therapists will work to optimize his mobility after surgery.
Some cases of osteosarcoma require partial or complete amputation of an arm or leg. The NOPCO (National Orthotics and Prosthetics Company) Brace Shop at Boston Children's Hospital provides each patient with an expertly made, customized prosthesis, and our physical therapists help children adjust to using them.
Supportive care is treatment to prevent and treat infections, side effects of treatments and complications. The goal is to keep your child comfortable during treatment. It also is an important part of preventing short- and long-term complications of the disease and treatment.
Your child’s prognosis (chance of recovery) and treatment options depend on a number of different factors, including:
In general, osteosarcomas in the limbs tend to be more treatable. Osteosarcomas in other locations are more difficult to treat and require more aggressive therapy. Prompt medical attention and appropriate therapy are important for the best prognosis.
Unfortunately, about 40 percent of children treated for osteosarcoma will experience relapse, or a return of the disease.
Our pediatric oncologists and surgeons are experienced in treating relapsed osteosarcoma. For children with relapsed osteosarcoma, we offer the highest standard of care including additional surgery and chemotherapy. We also provide access to newly developed treatments through phase I and phase II clinical trials at Dana-Farber/Boston Children’s and the Children’s Oncology Group.
Childhood cancer was once considered to always be fatal, but today, the majority of pediatric cancer patients can expect to be long-term survivors.
Survivorship comes with numerous complex issues: the long-term effects of treatment and the risk of second cancers, as well as social and psychological concerns. Children treated for osteosarcoma may require long-term physical and occupational therapy and in some cases may need a brace or prosthesis to help them remain mobile and active.
In addition, children treated for osteosarcoma should visit a survivorship clinic every year to:
A typical follow-up visit may include some or all of the following:
Since 1993, physicians, nurses, researchers and psychologists in our survivorship clinic at the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute have helped thousands of survivors of pediatric cancers, treated at the institute and at other hospitals, to manage these long-term consequences.
Here are some services that you will encounter at the Perini Clinic:
Dana-Farber/Boston Children’s was one of the first centers in the United States to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma.
Apart from our very active basic research program on osteosarcoma and phase I and phase II clinical trials at Dana-Farber/Boston Children’s, we also have available all Children’s Oncology Group clinical trials for newly diagnosed, non-metastatic and metastatic osteosarcoma.
Here is some of the investigations that our researchers are currently working on:
For many children with rare or hard-to-treat conditions, clinical trials provide new options.
Our orthopedic surgeons, clinicians, and families discuss rotationplasty, a surgical option for treating certain bone tumors. It allows a child to avoid full amputation of the leg.