Therapy of the osteosarcoma
Previously, therapy was limited to the surgical removal of the osteosarcoma. However, since osteosarcoma has a very strong tendency to form metastases, approximately 20% of all patients already have metastases at the time of diagnosis and probably many more suffer from so-called micrometastases that cannot be diagnosed using conventional diagnostic methods, a two-phase form of therapy has been adopted. This “combination therapy” includes Preoperatively performed neoadjunctive chemotherapy is carried out with the aim of reducing the size of the tumor before surgery (= volume reduction), destroying any invisible micrometastases that may be present and, ideally, achieving devitalization.
It is usually applied over a period of ten weeks. Pre-operative chemotherapy is followed by surgical removal of the tumor, which is usually followed by a “radical” approach. This means that the tumor is cleared out very extensively in order to remove as much of the diseased tissue as possible.
In certain cases, it may be necessary to continue chemotherapy after the operation. Due to the low sensitivity of an osteosarcoma with regard to the use of radiation therapy, the same is not considered for the treatment of an osteosarcoma.
- The chemotherapeutic pretreatment
- The surgical removal of the tumor
Therapy goals: First and foremost, the preservation of life within the framework of a therapy is in the foreground.
As a result, a very “radical” approach is taken, especially in the surgical field. Of course, one tries to maintain the same, for example in the case of osteosarcomas in extremities. However, the goal of healing is always in the foreground, even if this may result in the loss of a limb.
Due to the sometimes quite unfavorable prognosis, a distinction is made in the course of therapy between As already mentioned, in both cases a balance must be struck between the greatest possible radicality and the least possible functional impairment. This is called a curative approach if the osteosarcoma was detected early, is localized and no or very limited metastases (maximum one lung metastasis) have been detected. The therapy is performed within the framework of the “combination therapy” described above.
If lung metastases are present, the surgical therapy is followed by a further approximately six weeks of chemotherapy, possibly followed by another operation. Palliative therapy is usually performed if there is a generalized tumor disease (osteosarcoma metastases outside the lung), the primary tumor is located on the trunk of the body and/or the primary tumor must be categorized as inoperable. Since there is usually little prospect of cure, the therapy has a life-prolonging (= palliative) character.
In the case of an inoperable primary tumor, usually only a palliative and life-prolonging therapy can be considered. The main focus is on maintaining the quality of life (pain relief, preservation of function).
- The healing (= curative) and
- The palliative (palliative) approach
