Osteosarcoma medical therapy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].
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Overview
The predominant therapy for osteosarcoma is neoadjuvant chemotherapy (chemotherapy given before surgey) followed by surgical resection. The most common drugs used to treat osteosarcoma are cisplatin, doxorubicin and high-dose methotrexate. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low. Samarium is a radioactive drug that targets areas where bone cells growing, such as tumor cells in the bone. It relieves bone pain.
Medical Therapy
The osteosarcoma treatment should be determined According to:[1][2][3][3][4][5][6][7][8]
- Patients age
- Patients overall health
- Patients medical history
- The osteosarcoma type
- The osteosarcoma stage (extent)
- The osteosarcoma location
- The osteosarcoma type
- Patients tolerance to specific medicines, procedures or therapies
Accordingly, up to this time the available treatment for osteosarcoma is one of a combination of the following treatments:
- Surgery
- Prosthetic fitting and training
- Radiation therapy
- Chemotherapy
- Antibiotic therapy to prevent and treat infections
- Rehabilitation
- Supportive care for the side effects of therapy
- Continued follow-up care
However, the current standard treatment for osteosarcoma is to use neoadjuvant chemotherapy (chemotherapy given before surgery) followed by surgical resection.
- The percentage of tumor cell necrosis (cell death) seen in the tumor after surgery gives an idea of the prognosis and also lets the oncologist know if the chemotherapy regimen should be altered after surgery.
- Standard therapy is a combination of limb-salvage orthopedic surgery and a combination of high dose methotrexate with leucovorin rescue, intra-arterial cisplatin, caffeine, adriamycin, ifosfamide with mesna, BCD, etoposide, and muramyl tripeptide (MTP).
- Fluids are given for hydration.
- Drugs like granisetron and ondansetron help with nausea and vomiting.
- Filgrastim, epoetin alfa, granulocyte colony stimulating factor help with white blood cell counts and neutrophil counts.
- Blood helps with anemia.
Chemotherapy regimens
- The most common chemotherapy combinations used to treat osteosarcoma are:
- Cisplatin, doxorubicin and high-dose methotrexate.
- Cisplatin and doxorubicin.
- Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low.
Samarium
- Samarium is a radioactive drug that targets areas where bone cells growing, such as tumor cells in the bone.
- It helps relieve pain caused by cancer in the bone.
- It also kills the blood cells in bone marrow.
- Treatment with samarium may be followed by stem cell transplant.
- Before treatment with samarium, stem cells (immature blood cells) are removed from the blood or bone marrow of the patient and are frozen and stored. After treatment with samarium is complete, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells.
References
- ↑ Bishop MW, Janeway KA, Gorlick R (February 2016). "Future directions in the treatment of osteosarcoma". Curr. Opin. Pediatr. 28 (1): 26–33. doi:10.1097/MOP.0000000000000298. PMC 4761449. PMID 26626558.
- ↑ Szewczyk M, Lechowski R, Zabielska K (March 2015). "What do we know about canine osteosarcoma treatment? Review". Vet. Res. Commun. 39 (1): 61–7. doi:10.1007/s11259-014-9623-0. PMC 4330401. PMID 25422073.
- ↑ 3.0 3.1 Biazzo A, De Paolis M (December 2016). "Multidisciplinary approach to osteosarcoma". Acta Orthop Belg. 82 (4): 690–698. PMID 29182106.
- ↑ Selmic LE, Griffin LR, Rector MH, Lafferty M, Pool R, Ehrhart NP (September 2016). "Treatment of extraskeletal osteosarcoma at a previous injection site resulting in prolonged survival in 1 dog". Can. Vet. J. 57 (9): 950–4. PMC 4982565. PMID 27587886.
- ↑ Swift KE, LaRue SM (March 2018). "Outcome of 9 dogs treated with stereotactic radiation therapy for primary or metastatic vertebral osteosarcoma". Vet Comp Oncol. 16 (1): E152–E158. doi:10.1111/vco.12362. PMID 29181871.
- ↑ Redondo A, Cruz J, Lopez-Pousa A, Barón F (December 2013). "SEOM clinical guidelines for the treatment of osteosarcoma in adults-2013". Clin Transl Oncol. 15 (12): 1037–43. doi:10.1007/s12094-013-1087-0. PMID 23907290.
- ↑ Gill J, Ahluwalia MK, Geller D, Gorlick R (January 2013). "New targets and approaches in osteosarcoma". Pharmacol. Ther. 137 (1): 89–99. doi:10.1016/j.pharmthera.2012.09.003. PMID 22983152.
- ↑ Meyers PA (2015). "Systemic therapy for osteosarcoma and Ewing sarcoma". Am Soc Clin Oncol Educ Book: e644–7. doi:10.14694/EdBook_AM.2015.35.e644. PMID 25993235.