Osteosarcoma - Childhood and Adolescence: Types of Treatment

Approved by the Cancer.Net Editorial Board, 08/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for children and teens with osteosarcoma. Use the menu to see other pages.

In general, cancer in children and teenagers is uncommon. This means it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That is why more than 60% of children with cancer are treated as part of a clinical trial when one is available. A clinical trial is a research study that tests a new approach to treatment. The “standard of care” is the best treatment known. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.

To take advantage of these newer treatments, all children with cancer should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist.

Treatment overview

In many cases, a team of doctors, nurses, and pharmacists works with the patient and the family to provide care. This is called a multidisciplinary team. Pediatric cancer centers often have extra support services for patients and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Descriptions of common types of treatment used for osteosarcoma are listed below. All people with high-grade osteosarcoma require surgery and chemotherapy for the highest chance of successful treatment. Radiation therapy is used for some patients. Your child's care plan also includes treatment for symptoms and side effects, an important part of cancer care. Treatment options and recommendations depend on several factors, including:

  • The type, stage, and grade of cancer

  • Possible side effects

  • The child’s overall health

  • The child’s and family’s preferences

Take time to learn about your child’s treatment options and be sure to ask questions about things that are unclear. Talk with your child’s doctor about the goals of each treatment and what your child can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your child's care. Shared decision making is particularly important for osteosarcoma because there are different treatment options. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding tissue during an operation. An orthopedic oncologist is a doctor who specializes in surgery when cancer affects the bone. In limb-sparing surgery, doctors use surgical techniques to help the child keep the use of the arm or leg and to give the limb a more normal appearance. Surgical techniques include bone grafting and reconstructive surgery. A bone allograft uses bone from another person to repair and rebuild damaged bone.

Limb-sparing surgery is used whenever possible. Sometimes, the operation that results in the most useful and strongest limb is different from the one that gives the most normal appearance.

Occasionally, doctors will need to remove a limb to ensure that the entire tumor has been eliminated. This is called amputation. If amputation is needed, rehabilitation can help the child maximize his or her physical function. Rehabilitation can also help a child cope with the social and emotional effects of losing a limb. Learn more about rehabilitation.

Learn more about the basics of cancer surgery. Before surgery, talk with your child's health care team about the possible side effects from the specific surgery you will have.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. Chemotherapy is given by a pediatric oncologist or medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets to the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill that is swallowed (orally). The chemotherapy used in osteosarcoma is typically given through an IV. Most children with osteosarcoma have a small box placed under the skin with a tube that goes into a large vein. This device, often called an infusaport or port-a-cath, allows direct access to veins to deliver chemotherapy. A small operation is needed to place the device.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. Your child may receive 1 drug at a time or a combination of different drugs given at the same time. Osteosarcoma chemotherapy generally takes more than 6 months to administer.

In high-grade osteosarcoma, nearly all children and teens receive this type of chemotherapy. The survival rate of people with localized, high-grade osteosarcoma without systemic chemotherapy is under 20%, as compared to 60% to 75% with chemotherapy. Chemotherapy is given both before and after surgery to destroy any tumor cells that are elsewhere in the body. Chemotherapy before surgery may facilitate surgery.

The side effects of chemotherapy depend on the individual and the dose used. With the therapy typically used for osteosarcoma side effects often include risk of infection, nausea and vomiting, hair loss, and loss of appetite. The health care team will manage these immediate side effects during treatment. These side effects usually go away after treatment is finished. Other side effects may continue after treatment. These may include decreased strength of the heart muscle, hearing loss, or decreased kidney function. The severity of the side effects depends on the type of drug given and the length of treatment. Learn more about long-term side effects in the Follow-up Care section.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. It is important to let the doctor know if your child is taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your child’s prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. When used, radiation treatment for osteosarcoma is usually external-beam radiation therapy. This is radiation therapy given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy for osteosarcoma is uncommon. This is because osteosarcoma is relatively resistant to radiation therapy. Radiation therapy is mostly reserved for people whose osteosarcoma can not be removed by another treatment or if some of the tumor remains after other treatment.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the cancer. Some treatment centers have specific programs for young adults that can help patients with their psychological and social needs.

Palliative care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. Your child may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your child’s doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child is experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body. This may also be called having “no evidence of disease” or being “NED.”

A remission may be temporary or permanent. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your child’s risk of recurrence and the treatment options may help you and your child feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery and chemotherapy. However, these treatments may be used in a different combination or given at a different pace. Your child’s doctor may suggest clinical trials that are studying new ways to treat recurrent osteosarcoma.

Treatment for recurrent osteosarcoma depends on 3 factors:

  • Where the cancer recurred

  • The type of treatment your child received for the original tumor

  • The overall health of your child

If the disease recurs in the lungs, surgery is often used to remove the nodules, or tumors, in the lung. In these situations, there is usually a better outcome for children who have the lung nodules completely removed. This is especially true if the disease has recurred after the initial treatment has been completed.

The doctor may use chemotherapy or other approaches, too. If the cancer comes back elsewhere in the body, the doctor may use a combination of drugs. If the cancer has spread to another bone or to a small number of other bones, the doctor may perform surgery, particularly if chemotherapy has worked well.

Whichever treatment plan is chosen, palliative care and supportive care will be important for relieving symptoms and side effects.

When cancer recurs, people with cancer and their families often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you and your family cope. Learn more about dealing with cancer recurrence.

If treatment does not work

Although treatment is successful for most children with cancer, sometimes it is not. If a child’s cancer cannot be cured or controlled, this is called advanced or terminal cancer. This diagnosis is stressful, and particularly when involving a child, adolescent and or young adult, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your child’s health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.

Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. For children, hospice care may have more to do with the needs of the patient and family instead of how long the patient is expected to live. Parents and guardians are encouraged to talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families.

Some children and teens may be happier if they can attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced cancer care planning.

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.