What are the treatment principles for osteosarcoma

The treatment of osteosarcoma is mainly based on high-dose individualized neoadjuvant chemotherapy (preoperative chemotherapy) and surgery. At present, based on neoadjuvant chemotherapy and the correct surgical plan, the 5-year disease-free survival rate can reach 50%-70%. The surgical plan should be determined according to the effect of preoperative chemotherapy and the surgical staging of the tumor. So what are the treatment principles of osteosarcoma?

Treatment principles for osteosarcoma:

1. Chemotherapy

The four most commonly used drugs are methotrexate, cisplatin, doxorubicin, and ifosfamide.

Chemotherapy drugs have obvious killing power against sensitive cancer cells, but the biggest drawback of chemotherapy drugs is that they are not selective. While killing tumor cells, they also kill a large number of normal cells, and thus quickly destroy the body's immune system function. Many cancer patients are forced to interrupt treatment, and cancer patients whose immune capacity is damaged face the danger of tumor metastasis again.

2. Surgery

① Limb-sparing surgery

It has gradually become the mainstream, with the best indication being stage IIA and IIB being a relative indication. Standardized chemotherapy is required for 6 to 8 weeks before surgery, and the resection margin should achieve radical resection or wide resection. It is best to do MRI and angiography before surgery to understand the exact range of the tumor and its relationship with large blood vessels. Bone defects are often replaced with artificial joints, and chemotherapy regimens are adjusted after surgery based on the tumor necrosis rate for 4 to 6 months.

② Amputation surgery

When limb salvage is not suitable or unconditional, amputation should be performed decisively. Chemotherapy may not be required before the operation, but chemotherapy is required after the operation.

The treatment principle of osteosarcoma should also be determined based on the effect of preoperative chemotherapy and the surgical staging of the tumor. In addition, the patient and family's wishes, the patient's age and psychological state, the location and size of the tumor, the condition of the soft tissue and neurovascular bundle, and the foreseeable postoperative function should also be considered.