What are the NCCN and ESMO treatment guidelines for stage IA-IB osteosarcoma?

Updated: Dec 04, 2018
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

Treatment recommendations for stages IA-IB (low grade) osteosarcomas are as follows:

  • Enrollment in a clinical trial should be considered when available; in addition, whenever possible patients should be referred to a tertiary care center with expertise in sarcoma, for treatment by a multidisciplinary team
  • Localized, low-grade osteosarcomas – The NCCN recommends wide excision alone; chemotherapy (see regimens below) prior to excision is not typically recommended but could be considered for periosteal lesions [30]
  • Low-grade intramedullary and surface osteosarcoma and periosteal sarcomas with pathological findings of high-grade disease – The NCCN recommends postoperative chemotherapy [30] ; ESMO-PaedCan-EURACAN recommends surgery alone for low-grade parosteal osteosarcomas, and finds no benefit for chemotherapy for periosteal lesions [31]
  • Unresectable or incompletely resected osteosarcoma – The NCCN and ESMO-PaedCan-EURACAN guidelines concur that combined photon/proton or proton beam radiotherapy for local control is an option [30, 31]

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