The Team Approach to Osteosarcoma of the Distal Femur in an Adolescent

• Published in: JBJS reviews Vol. 5; no. 12; p. e5
• Main Authors: Stitzlein, RN, Wojcik, J, Sebro, RA, Balamuth, NJ, Weber, KL
• Format: Journal Article
• Language: English
• Published: 01-12-2017
• ISSN: 2329-9185
• DOI: 10.2106/JBJS.RVW.17.00030

Osteosarcoma, while rare, is the most common primary bone cancer and accounts for up to 10% of all new pediatric cancer diagnoses annually in the United States. Most commonly, osteosarcoma affects the distal femur and occurs as a high-grade intramedullary (conventional) subtype. Patients with osteosarcoma are treated with a multi-disciplinary team approach.
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Often, an orthopaedic oncologist initiates the workup after making a presumptive diagnosis based on classic clinical and radiographic findings. Advanced imaging and a tissue biopsy are obtained to evaluate the extent of disease and to histologically confirm the diagnosis. Musculoskeletal radiologists and pathologists are
key
team members who evaluate the imaging and tissue samples to make a definitive diagnosis, establish a prognosis, and help the clinicians develop a treatment plan. Medical/pediatric oncologists are essential team members who provide the appropriate neoadjuvant and adjuvant chemotherapy treatment and assist with long-term surveillance to monitor for local or distant relapse. Orthopaedic oncologists develop and execute a plan for resection of the tumor followed by appropriate reconstruction. The current standard of care for distal femoral osteosarcoma is neoadjuvant chemotherapy followed by limb salvage for the surgically resectable tumor, reconstruction of the bone and soft tissue defect, and adjuvant chemotherapy. The survival for patients with isolated osteosarcoma is approximately 70% and has not substantially improved in over 25 years.
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