Team Approach: Osteosarcoma of the Distal Part of the Femur in Adolescents

Abstract

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.1 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.2–6

Characteristics, Management, and Outcomes of Patients With Osteosarcoma: An Analysis of Outcomes From the National Cancer Database

“…3 Osteosarcoma has a predilection for invading the metaphysis of the long bones of the appendicular skeleton, chiefly the distal femur and proximal tibia. 4 Osteosarcoma can also affect the axial skeleton/other locations, although this is less common. 4…”

Correlation of histopathology and multi-modal magnetic resonance imaging in childhood osteosarcoma: Predicting tumor response to chemotherapy

“…In fact, it is not surprising that conventional MR images could be informative (to a certain extent) in approximating the degree of tumor necrosis. Researchers have shown that visual interpretations of conventional MR images are indeed possible for the prognosis of osteosarcoma [ 10 , 51 , 52 ]. First, intraosseous (intramedullary) tumor is evident on T1-weighted MR images as areas of low signal intensity.…”

Deep Learning Assisted Diagnosis of Musculoskeletal Tumors Based on Contrast‐Enhanced Magnetic Resonance Imaging

“…Patients with musculoskeletal tumors are usually treated with a multidisciplinary approach 25,26 . At the first visit, patients may be referred to orthopedists, oncologists, or radiologists.…”

“…Patients with musculoskeletal tumors are usually treated with a multidisciplinary approach. 25,26 At the first visit, patients may be referred to orthopedists, oncologists, or radiologists. However, it is difficult for physicians to develop sufficient experience in diagnosing musculoskeletal tumors due to its rarity.…”