This protocol covers patients with high-grade osteosarcoma in whom the primary tumour or metastatic disease cannot be surgically removed, requiring a systemic treatment strategy adapted to disease extent and individual patient factors.

Clinical scenario: Conventional osteosarcoma is always high-grade. When the primary site or metastatic disease is unresectable, systemic therapy forms the backbone of management. Radiotherapy may additionally be considered where surgery would be unacceptably morbid or where local control options are limited.

Treatment overview

Management centres on combination chemotherapy, with regimen selection informed in part by patient age, alongside consideration of modern radiotherapy techniques for local disease control — the full protocol details the complete regimen, selection criteria, and sequencing.

References

DOI: 10.1016/j.annonc.2021.08.1995

Conventional osteosarcoma is always high-grade.

RT may be considered in osteosarcoma patients with unresectable primary tumours where surgery would be unacceptably morbid, or as adjuvant treatment of tumours at high risk of LR and with limited option for further surgery [IV, B].

Doxorubicin, cisplatin, high-dose methotrexate (HD-MTX) and ifosfamide have antitumour activity in osteosarcoma [I, A].

In patients >40 years, preferred regimens combine doxorubicin, cisplatin and ifosfamide [III, B].

Modern RT techniques [including heavy particles and intensity-modulated RT (IMRT)] may offer a technical advantage to deliver high doses and should be considered where appropriate, especially in paediatric patients or young adults.

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High-Grade Osteosarcoma — Unresectable Primary Tumour or Unresectable Metastatic Disease

References