What are the NCCN treatment guidelines for stages IIA-IVB osteosarcoma?

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

NCCN treatment recommendations for stages IIA-IVB (high grade) and metastatic disease include the following [30] :

  • 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
  • Preoperative chemotherapy is recommended for all stages of high-grade disease (category 1)
  • If good margins can be achieved, limb-sparing surgery is preferred for patients with good histologic response to chemotherapy; amputation for tumors in unfavorable anatomical locations
  • Postoperative chemotherapy should continue with preoperative regimen if there has been a good histologic response; for patients with a poor response, consider postoperative chemotherapy with a different regimen
  • Surgical re-resection with or without radiation therapy for positive margins should be considered
  • For unresectable osteosarcomas following preoperative chemotherapy, consider radiation therapy or chemotherapy

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