Is osteosarcoma a type of bone tumor?
Osteosarcoma is one of the most common primary malignant tumors of bone, most commonly occurring in adolescents, most commonly in the distal femur, proximal tibia and proximal humerus epiphysis, and is characterized by the production of bone-like stroma by tumor cells.
What is secondary osteosarcoma?
Simply put, it is secondary to other pre-existing bone lesions or after radiation therapy. Common benign bone tumors such as osteoblastoma, giant cell tumor of bone, or aneurysmal bone cysts can develop secondary to osteosarcoma, as can chronic bone diseases such as Paget’s disease and osteolymphoma after radiation therapy.
Does trauma increase the incidence of osteosarcoma?
There is no evidence-based evidence, but when we review the medical history of patients with osteosarcoma, we find that many patients have symptoms that often occur or become significant after local trauma. The general reason for this would be that osteosarcoma causes skeletal lesions (e.g., moths eating wood) that can cause pain or even fractures with minor trauma that would not cause typical pain symptoms in a normal person.
Osteosarcoma is most common in adolescents, isn’t it?
There are two peaks in the age of prevalence of osteosarcoma, the first peak is in adolescents and the second peak is in adults around 30-50 years old, with adolescents being the majority in China.
What is the difference between pain caused by osteosarcoma and growing pains?
Pain due to osteosarcoma is often accompanied by local soft tissue masses, or painless masses in the limbs in the early stage, with gradual pain. The nature of its pain is obvious with night pain or rest pain, and drugs are usually ineffective or ineffective. Growing pains are usually short-lived pains with no soft tissue masses in the limb, while nocturnal or rest pains are not obvious. In short, if you have nocturnal pain, rest pain or pain with limb lumps, you should be aware of the possibility of osteosarcoma or other malignant bone tumors.
How can I detect osteosarcoma on my own?
Osteosarcoma is rare and difficult to detect on your own, but if an adolescent has unexplained swelling of the limb with pain, especially pain at night or pain at rest, you should be careful of osteosarcoma or other malignant bone tumors and need to go to the hospital to take a film or other tests to rule them out.
Is surgery the first choice for osteosarcoma?
Surgery is only one of the important components in the comprehensive treatment of osteosarcoma. Surgery alone cannot cure osteosarcoma patients, but must be combined with neoadjuvant or adjuvant chemotherapy to achieve a good curative effect. The conventional treatment plan of our hospital bone oncology department is preoperative chemotherapy + surgery + postoperative chemotherapy, if necessary, combined with targeted and biological therapy to achieve a good curative effect for osteosarcoma patients.
Do we have to amputate and debone?
At present, with the development of neoadjuvant chemotherapy and extensively resected limb-preserving surgery, most patients with primary osteosarcoma in our bone oncology department can undergo limb-preserving surgery.
However, if some patients are delayed too long or the tumor invades the local blood vessels and nerves without proper diagnosis and treatment in early stage, the condition of limb preservation is lost.
Is amputation confirmed when the disease is diagnosed or after preoperative chemotherapy?
Amputation or not is mainly based on preoperative systemic and local examination, especially combined with MRI images at the time of diagnosis and preoperatively, if the tumor invades local vascular nerves, the condition of limb preservation is lost.
Indications for limb preservation surgery: Ennecking stage IIA, stage IIB with good response to chemotherapy, no major neurovascular involvement; systemic condition and local soft tissue conditions allow for extensive resection; no metastases or metastatic lesions can be cured; patient has a strong desire for limb preservation; economically able to afford the high cost of chemotherapy.
In conclusion, whether to perform amputation or limb preservation surgery depends on the stage of the tumor and the response of the tumor to chemotherapy, especially the latter is more important. Meanwhile, the effective implementation of adjuvant chemotherapy is a key aspect of limb preservation surgery.
What are the ways of limb preservation surgery?
There are various types of limb preservation surgery: tumor segment removal + allogeneic bone + artificial prosthesis; children can be extended; joint fusion; artificial prosthesis replacement; allogeneic bone and joint graft; autologous bone graft with blood vessels; tumor bone inactivation and reimplantation, etc. The key to limb preservation surgery is to use reasonable surgical boundary to remove the tumor completely. The scope of wide resection includes the tumor body, envelope, reaction zone and some surrounding normal tissues, and the osteotomy plane should usually be 125px beyond the tumor edge, and the resection range of soft tissue is 1~125px beyond the reaction zone.
Is it true that the younger the age, the worse the effect of limb preservation treatment?
Age is only a reference, but it is also related to the extent of tumor invasion, individual developmental status and response to chemotherapy. In theory, as long as the principle of limb preservation is suitable, all limbs can be preserved, but if the age is too young, such as under 5 years old, different surgical transition is needed.
After metastasis to the lung, can it still be treated surgically?
It depends on the metastasis site, size, number and the effect of chemotherapy or targeted therapy.
Do all osteosarcomas require chemotherapy before surgery?
The current international consensus is to administer neoadjuvant chemotherapy before surgery, but if the patient is intolerant to chemotherapy, the tumor is too large, or the disease is progressing rapidly, then the choice can be made based on the specific condition.
Will prolonged chemotherapy delay the treatment of the disease?
Usually 4-6 neoadjuvant chemotherapy sessions before surgery will be considered for surgical treatment. Prolonged chemotherapy is only for patients who cannot undergo surgery, but often has poor results due to tumor not being resected, drug resistance, etc.
Does chemotherapy increase the success rate of limb-preserving treatment?
If the patient is sensitive to chemotherapy and the tumor shrinks, it can increase the outcome and success rate of limb preservation.
Will preoperative chemotherapy make surgery more difficult, such as increasing the incidence of fistula?
However, for some patients who are not sensitive to chemotherapy or whose tumors increase in size instead of shrinking during chemotherapy, limb preservation and prognosis are less favorable than for chemotherapy-sensitive patients.
Do I have to amputate my limb if I am not sensitive to preoperative chemotherapy?
If the indication for limb preservation is met, limb preservation is possible even if the patient is not sensitive to preoperative chemotherapy, but postoperative attention needs to be switched to second-line or targeted chemotherapy drugs.
Which osteosarcomas require chemotherapy after surgery?
Nine to 12 postoperative chemotherapy sessions are generally recommended after osteosarcoma surgery.
Is the higher the dose of chemotherapy after surgery the better?
Chemotherapy drugs should be balanced between tumor killing and human tolerance. If the patient has good nutritional condition and can tolerate it, the dose of chemotherapy drugs can be adjusted upward appropriately, but it must be applied within the applied dose range of chemotherapy drugs.
Is thymidine useful for osteosarcoma treatment?
Thymus peptide does not directly kill osteosarcoma cells, but can increase human immunity, so it can be applied as an adjuvant drug.