Improving outcomes in difficult bone cancers using multimodality therapy, including radiation: Physician and nursing perspectives

Abstract

Principles of therapy are similar for Ewing's sarcoma and osteosarcoma. Chemotherapy or surgery alone cures few patients. Multimodality measures are needed for durable response. Quality of life and function are very important short- and long-term considerations. The spine, sacrum, pelvis, ankle, hand, mediastinum, pulmonary hilum, and chest wall are examples of bone cancer locations for which surgery is difficult. Patients with positive margins may need radiation and may experience systemic therapy delay, recurrence, loss of function, or any combination of these. When radiation is used as a means of local control, concomitant chemotherapy can increase its effectiveness. Options for difficult Ewing's sarcoma and osteosarcoma situations and multimodality solutions, including 1 mCi/kg of samarium and proton therapy, are discussed. Combination radiation and chemotherapy regimens are summarized, and organization of patients, caregivers, and medical teams for multimodality therapy is described, along with tools used in our institution that aid in this process.

JNK pathway mediates curcumin-induced apoptosis and autophagy in osteosarcoma MG63 cells

“…Osteosarcoma is one of the most common primary malignant neoplasms in children, adolescents, and young adults (1). The introduction of chemotherapy has lead to a significant improvement in the prognosis of patients with localized osteosarcoma, and long-term survival rates of <20% have been observed to improve to >65% after the use of multiagent chemotherapy regimens (2).…”

Outpatient Chemotherapy plus Radiotherapy in Sarcomas: Improving Cancer Control with Radiosensitizing Agents

“…An organized approach is needed to achieve the art of the possible. 109 As more is learned about the tumor microenvironment and effects of radiation, additional approaches to improve cancer control using concurrent chemotherapy plus radiation are possible. The effect of chemotherapy plus radiation on tumor neovasculature, vascular endothelial growth factor (VEGF) production/inhibition on tumor oxygenation, and chemotherapy penetration are probably important parameters of cancer control.…”

Physical Therapy in Patients with Cancer

“…Treatment includes surgery, chemotherapy, and radiation therapy [83,84]. Amputation may be necessary if limb-sparing surgery is not possible or had no positive outcomes [85].…”