Osteosarcoma Diagnosis and Treatment

Introduction to Osteosarcoma

The European Society for Medical Oncology recommends that all patients with radiographic findings suggestive of osteosarcoma must be immediately referred to a specialized bone sarcoma center before any biopsy is performed, as inappropriate biopsy techniques can irrevocably compromise limb salvage and cure 1, 2, 3, 4

Persistent non-mechanical bone pain, predominantly at night, is the hallmark symptom that should prompt immediate radiological assessment, according to the European Society for Medical Oncology 1
Pain often occurs at rest and during nighttime, followed by localized swelling and limitation of joint movement, as reported by the European Society for Medical Oncology 2, 4, 5

The European Society for Medical Oncology recommends conventional radiograph in two planes as the mandatory first radiological investigation 1
MRI of the whole compartment with adjacent joints is the gold standard for local staging of extremity and pelvic tumors, as stated by the European Society for Medical Oncology 1, 2, 3, 4
Chest CT is used to detect pulmonary metastases, according to the European Society for Medical Oncology 2, 3, 4

The European Society for Medical Oncology recommends measuring alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) at baseline, as elevated levels correlate with adverse outcomes 2, 3, 4, 6
A comprehensive baseline panel, including complete blood count with differential, blood group typing, coagulation profile, serum electrolytes, renal function tests, and liver function tests, is necessary before treatment, as recommended by the European Society for Medical Oncology 2, 3, 4, 6, 8

The biopsy must be performed at the reference bone sarcoma center by the surgical team who will perform definitive tumor resection or by a dedicated interventional radiologist, as stated by the European Society for Medical Oncology 1, 2, 3
Core-needle biopsy under imaging control is appropriate for most patients as an alternative to open biopsy, according to the European Society for Medical Oncology 1

The European Society for Medical Oncology recommends treatment in specialized centers with access to the full spectrum of care, including pediatric/medical oncologists, orthopedic oncologists, surgeons, pathologists, radiologists, and pain management 4, 7
Curative treatment consists of surgery and chemotherapy, with multimodal treatment increasing disease-free survival from 10-20% (surgery alone) to >60%, as reported by the European Society for Medical Oncology 4

Detectable metastases at presentation, proximal extremity or axial tumor site, large tumor volume, elevated serum ALP or LDH, and poor histological response to preoperative chemotherapy are adverse prognostic indicators, according to the European Society for Medical Oncology 2, 4, 7, 8

Never perform biopsy before referral to a bone sarcoma center, as this is the single most critical error that compromises cure, according to the European Society for Medical Oncology 1, 2, 3, 4, 8