Treatment Option Overview
There are different types of treatment for patients with osteosarcoma or malignant fibrous histiocytoma (MFH) of bone.
Different types of treatment are available for children with osteosarcoma or malignant fibrous histiocytoma (MFH) of bone. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.
Children with osteosarcoma or MFH should have their treatment planned by a team of health care providers with expertise in treating cancer in children.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating osteosarcoma and MFH and who specialize in certain areas of medicine. These may include the following specialists:
- Orthopedic surgeon.
- Radiation oncologist.
- Rehabilitation specialist.
- Pediatric nurse specialist.
- Social worker.
- Psychologist.
Some cancer treatments cause side effects months or years after treatment has ended.
Side effects from cancer treatment that begin during or after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include the following:
- Physical problems.
- Changes in mood, feelings, thinking, learning, or memory.
- Second cancers (new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer 1 for more information).
Four types of standard treatment are used:
Surgery to remove the entire tumor will be done when possible. Chemotherapy may be given before surgery to make the tumor smaller. This is called neoadjuvant chemotherapy. Chemotherapy is given so less bone tissue needs to be removed and there are fewer problems after surgery.
The following types of surgery may be done:
- Wide local excision: Surgery to remove the cancer and some healthy tissue around it.
- Limb-sparing surgery: Removal of the tumor in a limb (arm or leg) without amputation, so the use and appearance of the limb is saved. Most patients with osteosarcoma in a limb can be treated with limb-sparing surgery. The tumor is removed by wide local excision. Tissue and bone that are removed may be replaced with a graft using tissue and bone taken from another part of the patient's body, or with an implant such as artificial bone. If a fracture is found at diagnosis or during chemotherapy before surgery, limb-sparing surgery may still be possible in some cases. If the surgeon is not able to remove all of the tumor and enough healthy tissue around it, an amputation may be done.
- Amputation: Surgery to remove part or all of an arm or leg. This may be done when it is not possible to remove all of the tumor in limb-sparing surgery. The patient may be fitted with a prosthesis (artificial limb) after amputation.
- Rotationplasty: Surgery to remove the tumor and the knee joint. The part of the leg that remains below the knee is then attached to the part of the leg that remains above the knee, with the foot facing backward and the ankle acting as a knee. A prosthesis may then be attached to the foot.
Studies have shown that survival is the same whether the first surgery done is a limb-sparing surgery or an amputation.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, patients are also given chemotherapy after surgery to kill any cancer cells that are left in the area where the tumor was removed or that have spread to other parts of the body. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
In the treatment of osteosarcoma and malignant fibrous histiocytosis of bone, chemotherapy is usually given before and after surgery to remove the primary tumor.
See Drugs Approved for Bone Cancer 2 for more information.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Osteosarcoma and MFH cells are not killed easily by radiation therapy. It may be used when a small amount of cancer is left after surgery or used together with other treatments.
Samarium is a radioactive drug that targets areas where bone cells are growing, such as tumor cells in bone. It helps relieve pain caused by cancer in the bone and it also kills blood cells in the bone marrow. It also is used to treat osteosarcoma that has come back after treatment in a different bone.
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 reinfused stem cells grow into (and restore) the body's blood cells.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site 3.
Targeted therapy is a treatment that uses drugs or other substances to find and attack specific cancer cells without harming normal cells.
One kind of targeted therapy being studied to treat recurrent osteosarcoma is a drug that stops cells from dividing and prevents the growth of new blood vessels that tumors need to grow. This drug is a type of kinase inhibitor and a type of antiangiogenesis agent.
Monoclonal antibody therapy is another type of targeted therapy being studied to treat recurrent osteosarcoma. This treatment uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Glossary Termsabdomen (AB-doh-men)The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.adjuvant therapy (A-joo-vunt THAYR-uh-pee) Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.amputation (am-pyoo-TAY-shun) Surgery to remove part or all of a limb or appendage.antibody (AN-tee-BAH-dee) A protein made by plasma cells (a type of white blood cell) in response to an antigen (a substance that causes the body to make a specific immune response). Each antibody can bind to only one specific antigen. The purpose of this binding is to help destroy the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen.blood (blud) A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.blood vessel (blud VEH-sel) A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.bone marrow (bone MAYR-oh) The soft, sponge-like tissue in the center of most bones. It produces white blood cells, red blood cells, and platelets.cancer (KAN-ser) A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.catheter (KA-theh-ter) A flexible tube used to deliver fluids into or withdraw fluids from the body.cavity (KA-vih-tee) A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.cell (sel) The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.cerebrospinal fluid (seh-REE-broh-SPY-nul FLOO-id) The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). Cerebrospinal fluid is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called CSF.chemotherapy (KEE-moh-THAYR-uh-pee) Treatment with drugs that kill cancer cells.clinical trial (KLIH-nih-kul TRY-ul) A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.combination chemotherapy (KOM-bih-NAY-shun KEE-moh-THAYR-uh-pee) Treatment using more than one anticancer drug.diagnosis (DY-ug-NOH-sis) The process of identifying a disease, such as cancer, from its signs and symptoms.drug (drug) Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.excision (ek-SIH-zhun) Removal by surgery.external radiation therapy (...RAY-dee-AY-shun THAYR-uh-pee) A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.follow-up (FAH-loh-up) Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.graft (graft) Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body.healthcare provider (HELTH-kayr proh-VY-der) A licensed person or organization that provides healthcare services.immune system (ih-MYOON SIS-tem) The complex group of organs and cells that defends the body against infections and other diseases.implant (im-PLANT) A substance or object that is put in the body as a prosthesis, or for treatment or diagnosis.infusion (in-FYOO-zhun) A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion.injection (in-JEK-shun) Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."internal radiation therapy (in-TER-nul RAY-dee-AY-shun THAYR-uh-pee) A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.joint (joynt) In medicine, the place where two or more bones are connected. Examples include the shoulder, elbow, knee, and jaw.kinase (KY-nays) A type of enzyme that causes other molecules in the cell to become active. Some kinases work by adding chemicals called phosphates to other molecules, such as sugars or proteins. Kinases are a part of many cell processes. Some cancer treatments target certain kinases that are linked to cancer.late effects (layt eh-FEKTS) Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.limb-sparing surgery (LIM spayr-ing SER-juh-ree) Surgery to remove a tumor in a limb (arm or leg) without removing all of the limb. Also called limb-salvage surgery.malignant fibrous histiocytoma (muh-LIG-nunt FY-brus HIS-tee-oh-sy-TOH-muh) A soft tissue sarcoma that usually occurs in the limbs, most commonly the legs, and may also occur in the abdomen. Also called malignant fibrous cytoma.medicine (MEH-dih-sin) Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.monoclonal antibody (MAH-noh-KLOH-nul AN-tee-BAH-dee) A type of protein made in the laboratory that can bind to substances in the body, including tumor cells. There are many kinds of monoclonal antibodies. Each monoclonal antibody is made to find one substance. Monoclonal antibodies are being used to treat some types of cancer and are being studied in the treatment of other types. They can be used alone or to carry drugs, toxins, or radioactive materials directly to a tumor.NCI NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.neoadjuvant therapy (NEE-oh-A-joo-vant THAYR-uh-pee) Treatment given as a first step to shrink a tumor before the main treatment, which is usually surgery, is given. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. It is a type of induction therapy.organ (OR-gun) A part of the body that performs a specific function. For example, the heart is an organ.osteosarcoma (OS-tee-oh-sar-KOH-muh) A cancer of the bone that usually affects the large bones of the arm or leg. It occurs most commonly in young people and affects more males than females. Also called osteogenic sarcoma.PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.pediatric (pee-dee-A-trik) Having to do with children.pediatric nurse specialist (pee-dee-A-trik ... SPEH-shuh-list) A registered nurse with an advanced degree in nursing who specializes in the care of children.pediatric oncologist (pee-dee-A-trik on-KAH-loh-jist) A doctor who specializes in treating children with cancer.primary tumor (PRY-mayr-ee TOO-mer) The original tumor.prosthesis (pros-THEE-sis) A device, such as an artificial leg, that replaces a part of the body.psychologist (sy-KAH-loh-jist) A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.radiation (RAY-dee-AY-shun) Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).radiation oncologist (RAY-dee-AY-shun on-KAH-loh-jist) A doctor who specializes in using radiation to treat cancer.radiation therapy (RAY-dee-AY-shun THAYR-uh-pee) The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.radioactive (RAY-dee-oh-AK-tiv) Giving off radiation.radioactive drug (RAY-dee-oh-AK-tiv...) A drug that contains a radioactive substance and is used to diagnose or treat disease, including cancer. Also called radiopharmaceutical.radioactive seed (RAY-dee-oh-AK-tiv...) A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.recur (ree-KER) To come back or to return.recurrent cancer (ree-KER-ent KAN-ser) Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.regional chemotherapy (REE-juh-nul KEE-moh-THAYR-uh-pee) Treatment with anticancer drugs directed to a specific area of the body.rehabilitation specialist (REE-huh-BIH-lih-TAY-shun SPEH-shuh-list) A healthcare professional who helps people recover from an illness or injury and return to daily life. Examples of rehabilitation specialists are physical therapists and occupational therapists.research study (reh-SERCH STUH-dee) A scientific study of nature that sometimes includes processes involved in health and disease. For example, clinical trials are research studies that involve people. These studies may be related to new ways to screen, prevent, diagnose, and treat disease. They may also study certain outcomes and certain groups of people by looking at data collected in the past or future.rotationplasty (roh-TAY-shun-PLAS-tee) Surgery used to remove a tumor in or near the knee joint, often in young people who are still growing. The knee and part of the thigh are removed. The part of the leg that remains below the knee is then attached to the part of the leg above the knee, with the foot facing backward and the ankle joint acting as a new knee. The patient is then fitted with an artificial lower leg and foot.samarium 153 (suh-MAYR-ee-um ...) A radioactive substance used in the treatment of bone cancer and bone metastases (cancers that have spread from the original tumor to the bone). Samarium 153 is a radioactive form of the element samarium. It collects in bone, where it releases radiation that may kill cancer cells. It is a type of radioisotope.second primary cancer (SEH-kund PRY-mayr-ee KAN-ser) Refers to a new primary cancer in a person with a history of cancer.side effect (side eh-FEKT) A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.social worker (SOH-shul WUR-ker) A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.specialist (SPEH-shuh-list) In medicine, a doctor or other health care professional who is trained and licensed in a special area of practice. Examples of medical specialists include oncologists (cancer specialists) and hematologists (blood specialists).stage (stayj) The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.standard therapy (... THAYR-uh-pee) Treatment that experts agree is appropriate, accepted, and widely used. Also called best practice, standard medical care, and standard of care.stem cell (stem sel) A cell from which other types of cells develop. For example, blood cells develop from blood-forming stem cells.stem cell transplant (stem sel tranz-plant) A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).surgeon (SER-jun) A doctor who removes or repairs a part of the body by operating on the patient.surgery (SER-juh-ree) A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.survival rate (ser-VY-vul ...) The percentage of people in a study or treatment group who are alive for a certain period of time after they were diagnosed with or treated for a disease, such as cancer. The survival rate is often stated as a five-year survival rate, which is the percentage of people in a study or treatment group who are alive five years after diagnosis or treatment. Also called overall survival rate.systemic chemotherapy (sis-TEH-mik KEE-moh-THAYR-uh-pee) Treatment with anticancer drugs that travel through the blood to cells all over the body.targeted therapy (TAR-geh-ted THAYR-uh-pee) A type of treatment that uses drugs or other substances, such as monoclonal antibodies, to identify and attack specific cancer cells. Targeted therapy may have fewer side effects than other types of cancer treatments.therapy (THAYR-uh-pee) Treatment.tissue (TIH-shoo) A group or layer of cells that work together to perform a specific function.toxin (TOK-sin) A poison made by certain bacteria, plants, or animals, including insects.tumor (TOO-mer) An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.vein (vayn) A blood vessel that carries blood to the heart from tissues and organs in the body.wide local excision (…LOH-kul ek-SIH-zhun) Surgery to cut out the cancer and some healthy tissue around it.x-ray (EX-ray) A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer. |
Table of Links | |
| 1 | http://www.cancer.gov/cancertopics/pdq/treatment/lateeffects/Patient |
| 2 | http://www.cancer.gov/cancertopics/druginfo/bonecancer |
| 3 | http://cancer.gov/clinicaltrials |
