Surgical and Medical Management of Osteosarcoma Clinical Briefing

The Penn Orthopaedics Sarcoma Program is devoted to the management of patients with benign and malignant tumors of bone and soft tissues. The Program’s mission is to build a world-class multidisciplinary clinical team complemented by a strong foundation of basic and translational research to better diagnose and treat patients with bone and soft-tissue sarcomas.

The most common primary malignant bone lesions (sarcomas) include osteosarcoma, chondrosarcoma and Ewing sarcoma. Primary bone sarcomas are rare (~1% of all adult cancers) and can occur from infancy through late adulthood. The majority of patients with these tumors have pain at the bony site in addition to swelling or a stiff adjacent joint. Because symptoms can mimic those of many common injuries or conditions, individualized bone cancer management at Penn Medicine begins with a confirmative diagnosis.

A complex process, accurate diagnosis of sarcoma involves imaging studies and an image-guided needle biopsy. These assays are then analyzed by an interdisciplinary team of musculoskeletal radiologists and pathologists, medical/pediatric oncologists, radiation oncologists and surgeons from orthopaedics, neurosurgery, plastics surgery and general surgery. MRI scans with specific tumor sequences allow Penn orthopaedic oncologists to better plan surgical procedures by accurately determining the tumor characteristics and extent of disease.

Once the diagnosis of bone sarcoma has been confirmed, treatment plans are designed. Treatment varies depending on tumor type and stage, location, patient age, and adjuvant or neoadjuvant medical treatments. The objectives of treatment include prevention of disease recurrence, progression or metastasis and preservation of limb function. Limb preservation techniques for malignant tumors of bone and soft tissue are a specialty of the Penn Orthopaedics Sarcoma Program.

Surgical management of bone sarcoma at Penn has benefited from advances in the technology of internal fixation, soft tissue attachments to prostheses, and biologic options to recreate living bone. Metal prosthetic joints have become the most common method of reconstruction for patients when bone sarcoma is near a joint. Improvements in biomechanics, metallurgy and engineering have allowed for the development of advanced, modular prostheses that provide a more durable, long-lasting reconstruction for patients who are candidates for limb salvage surgery.

Future advances in the treatment of patients with osteosarcoma or other sarcomas will come from the laboratory in the form of new drugs or biologic agents that can specifically target the tumor cells to prevent metastasis.