Treatment of High-Grade Osteosarcoma with Unresectable Primary Tumour or Unresectable Metastatic Disease
Conventional osteosarcoma is always high-grade. When the primary tumour is unresectable — or when metastatic disease cannot be surgically addressed — a specific treatment framework applies.
Clinical scenario: High-grade osteosarcoma in which the primary tumour is unresectable, or where metastatic disease is unresectable. This includes cases where surgery would be unacceptably morbid or where there is limited option for further surgical intervention.
Treatment approach: Management in this setting involves chemotherapy regimens; radiotherapy may also be considered in certain patients. The complete protocol — including regimen options, combinations, and selection criteria — is detailed in the full evidence-based document.
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].
- Treatment choice may take into account prior DFS, ChT regimens previously used and often includes ifosfamide or cyclophosphamide, possibly in association with etoposide and/or carboplatin [III, B], and other active drugs including gemcitabine and docetaxel [IV, C].
- RT may have a role in palliation.
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