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Annals of Oncology : Official Journal... Oct 2010The successful treatment of patients with osteosarcoma requires close cooperation within an experienced multidisciplinary team including pediatric or medical... (Review)
Review
The successful treatment of patients with osteosarcoma requires close cooperation within an experienced multidisciplinary team including pediatric or medical oncologists, surgeons, pathologists and radiologists. Therefore, therapy should be performed in specialized centers able to provide access to the full spectrum of care. As in other rare malignancies, treatment should be administered within prospective multicenter trials. Therapy must include complete surgical removal of all detectable tumor sites as well as multiagent chemotherapy. The chemotherapy regimen should include several or all of the following four drugs: doxorubicin, high-dose methotrexate with leukovorin-rescue, cisplatin and ifosfamide. Preoperative (neoadjuvant) plus postoperative (adjuvant) polychemotherapy should be preferred, because it allows preparation for safe surgery and preparation of the appropriate prosthesis for the individual patient. The choice of the postponed definitive surgical procedure should be influenced by the anatomical site of the primary tumor, its relationship to neighboring structures, such as vessels and nerves, age and growth potential of the patient, and probably also by the response of the tumor to preoperative chemotherapy. A major, as yet unsolved, problem is the dismal prognosis for patients with unresectable or relapsed osteosarcomas. Novel approaches are needed in order to improve their prognosis.
Topics: Bone Neoplasms; Combined Modality Therapy; Humans; Neoplasm Metastasis; Neoplasm Staging; Osteosarcoma; Prognosis; Recurrence
PubMed: 20943636
DOI: 10.1093/annonc/mdq276 -
Cancer Letters Mar 2021Osteosarcoma (OS) is the most common primary malignancy of the bone and has a high propensity for local invasion and metastasis. Although combining surgery with... (Review)
Review
Osteosarcoma (OS) is the most common primary malignancy of the bone and has a high propensity for local invasion and metastasis. Although combining surgery with chemotherapy has immensely improved the outcomes of osteosarcoma patients, the prognosis of metastatic or recurrent osteosarcomas is still unsatisfactory. Immunotherapy has proven to be a promising therapeutic strategy against human malignancies and improved understanding of the immune response to OS, and biomarker development has increased the number of patients who benefit from immunotherapies in recent years. Here, we review recent advances in immunotherapy in osteosarcoma and discuss the mechanisms and status of immunotherapies in both preclinical and clinical trials as well as future therapies on the horizon. These advances may pave the way for novel treatments requisite for patients with osteosarcoma in need of new therapies.
Topics: Biomarkers, Tumor; Humans; Immunotherapy; Neoplasm Recurrence, Local; Osteosarcoma; Prognosis; Tumor Microenvironment
PubMed: 33359211
DOI: 10.1016/j.canlet.2020.12.024 -
Cells Apr 2020Osteosarcomas are the most frequent primary bone sarcomas, affecting mainly children, adolescents, and young adults, and with a second peak of incidence in elderly... (Review)
Review
Osteosarcomas are the most frequent primary bone sarcomas, affecting mainly children, adolescents, and young adults, and with a second peak of incidence in elderly individuals. The current therapeutic management, a combined regimen of poly-chemotherapy and surgery, still remains largely insufficient, as patient survival has not improved in recent decades. Osteosarcomas are very heterogeneous tumors, both at the intra- and inter-tumor level, with no identified driver mutation. Consequently, efforts to improve treatments using targeted therapies have faced this lack of specific osteosarcoma targets. Nevertheless, these tumors are inextricably linked to their local microenvironment, composed of bone, stromal, vascular and immune cells and the osteosarcoma microenvironment is now considered to be essential and supportive for growth and dissemination. This review describes the different actors of the osteosarcoma microenvironment and gives an overview of the past, current, and future strategies of therapy targeting this complex ecosystem, with a focus on the role of extracellular vesicles and on the emergence of multi-kinase inhibitors.
Topics: Animals; Bone Remodeling; Humans; Immune System; Mesenchymal Stem Cells; Molecular Targeted Therapy; Osteosarcoma; Tumor Microenvironment
PubMed: 32326444
DOI: 10.3390/cells9040976 -
Nature Reviews. Cancer Nov 2014For the past 30 years, improvements in the survival of patients with osteosarcoma have been mostly incremental. Despite evidence of genomic instability and a high... (Review)
Review
For the past 30 years, improvements in the survival of patients with osteosarcoma have been mostly incremental. Despite evidence of genomic instability and a high frequency of chromothripsis and kataegis, osteosarcomas carry few recurrent targetable mutations, and trials of targeted agents have been generally disappointing. Bone has a highly specialized immune environment and many immune signalling pathways are important in bone homeostasis. The success of the innate immune stimulant mifamurtide in the adjuvant treatment of non-metastatic osteosarcoma suggests that newer immune-based treatments, such as immune checkpoint inhibitors, may substantially improve disease outcome.
Topics: Animals; Antineoplastic Agents; Bone Development; Humans; Osteosarcoma; Translational Research, Biomedical
PubMed: 25319867
DOI: 10.1038/nrc3838 -
International Journal of Molecular... Jul 2020Osteosarcomas (OSs) are bone tumors most commonly found in pediatric and adolescent patients characterized by high risk of metastatic progression and recurrence after... (Review)
Review
Osteosarcomas (OSs) are bone tumors most commonly found in pediatric and adolescent patients characterized by high risk of metastatic progression and recurrence after therapy. Effective therapeutic management of this disease still remains elusive as evidenced by poor patient survival rates. To achieve a more effective therapeutic management regimen, and hence patient survival, there is a need to identify more focused targeted therapies for OSs treatment in the clinical setting. The role of the OS tumor stroma microenvironment plays a significant part in the development and dissemination of this disease. Important components, and hence potential targets for treatment, are the tumor-infiltrating macrophages that are known to orchestrate many aspects of OS stromal signaling and disease progression. In particular, increased infiltration of M2-like tumor-associated macrophages (TAMs) has been associated with OS metastasis and poor patient prognosis despite currently used aggressive therapies regimens. This review aims to provide a summary update of current macrophage-centered knowledge and to discuss the possible roles that macrophages play in the process of OS metastasis development focusing on the potential influence of stromal cross-talk signaling between TAMs, cancer-stem cells and additional OSs tumoral microenvironment factors.
Topics: Bone Neoplasms; Humans; Neoplasm Metastasis; Osteosarcoma; Signal Transduction; Tumor Microenvironment; Tumor-Associated Macrophages
PubMed: 32717819
DOI: 10.3390/ijms21155207 -
Clinical Orthopaedics and Related... Sep 1975Radiation therapy in the treatment of osteosarcoma has been considered with respect of the subclinical metastatic disease in the lung and the primary lesion. Emphasis is... (Review)
Review
Radiation therapy in the treatment of osteosarcoma has been considered with respect of the subclinical metastatic disease in the lung and the primary lesion. Emphasis is given to the necessity of coordinating the management plan of the primary lesion with an adjuvant program. Evaluation of the efficacy of a conservative treatment of the primary lesion by radiation therapy and chemotherapy is considered a proper subject for clinical study. A proper biopsy technique and several practical aspects of technique of radiation therapy in management of osteosarcomas of bone are important factors in survival time of individual patients.
Topics: Antineoplastic Agents; Biopsy; Bone Neoplasms; Humans; Jaw Neoplasms; Lung Neoplasms; Methods; Neoplasm Metastasis; Osteosarcoma
PubMed: 1098830
DOI: 10.1097/00003086-197509000-00009 -
Journal of Adolescent and Young Adult... Sep 2017Macrophages appear to have a fundamental role in the pathogenesis of osteosarcoma. These highly diverse plastic cells are subdivided into classical or inflammatory... (Review)
Review
Macrophages appear to have a fundamental role in the pathogenesis of osteosarcoma. These highly diverse plastic cells are subdivided into classical or inflammatory macrophages known as M1 and alternative macrophages, which decrease inflammation and are reparative, called M2. Although primary and metastatic osteosarcomas are infiltrated with M2 macrophages, targeting the M1 macrophages with the immune adjuvant muramyl tripeptide phosphatidyl ethanolamine (MTP-PE) has been the greatest recent therapeutic advance in osteosarcoma. This discrepancy between the presence of M2 and activation of M1 macrophages is intriguing and is likely explained either by the plasticity of M1 and M2 macrophages or nonclassical patrolling monocytes (PMos). To date, MTP-PE has been approved in combination with chemotherapy for nonmetastatic osteosarcoma, but its use in metastatic tumors has not been investigated. In this review, we focus on macrophages, monocytes, and osteoclasts, their role in osteosarcoma, and the potential for targeting these cells in this disease.
Topics: Antineoplastic Agents; Bone Neoplasms; Cell Transformation, Neoplastic; Humans; Macrophages; Molecular Targeted Therapy; Monocytes; Osteoclasts; Osteosarcoma
PubMed: 28263668
DOI: 10.1089/jayao.2016.0078 -
ORL; Journal For Oto-rhino-laryngology... 2023Primary osteosarcomas are rarely seen in areas other than bone, although they can occur in sites such as the thigh, anal region, hand, etc. We present a case of primary...
Primary osteosarcomas are rarely seen in areas other than bone, although they can occur in sites such as the thigh, anal region, hand, etc. We present a case of primary extraskeletal osteosarcoma of the thyroid, of which there are only 29 previous reported cases. Presentations and treatment options for this type of tumor vary. Through this case report, we discuss the similarities and differences of the patient's presentation compared with other documented cases, imaging, the rationale behind treatment, and the current clinical course.
Topics: Humans; Thyroid Gland; Soft Tissue Neoplasms; Osteosarcoma; Bone Neoplasms
PubMed: 36318896
DOI: 10.1159/000525183 -
Acta Orthopaedica Belgica Dec 2016Osteosarcoma is a malignant bone tumor composed of mesenchymal cells producing osteoid and immature bone. Osteosarcoma is the most frequent primary malignant bone tumor,... (Review)
Review
Osteosarcoma is a malignant bone tumor composed of mesenchymal cells producing osteoid and immature bone. Osteosarcoma is the most frequent primary malignant bone tumor, if we excluded myeloma, a haematologic disease. The incidence of osteosarcoma is 2-3/million/year, but is higher in adolescence, in which the annual incidence peaks at 8-11/million/year at 15-19 years of age. Local pain, followed by localized swelling and limitation of joint movement, are the typical signs and symptoms. Correct diagnosis can be achieved through a correct approach to the disease and the combination of clinical and radiographic aspects. The final step to confirm the diagnosis is the biopsy. Computer Tomography of the chest and Positron-Emission Tomography are mandatory to complete the staging, which is performed according the Musculoskeletal Tumor Society staging system. A multidisciplinary approach is needed both to get to a correct diagnosis (orthopaedic surgeon, radiologist and histopathologist) and to perform definitive treatment. Multidisciplinary approach should be performed in reference centers able to provide access to the full spectrum of care and where orthopaedic surgeon, oncologist, histopathologist, radiologist and radiotherapist can cooperate. The management of osteosarcoma is based primarily on neo-adjuvant and adjuvant chemotherapy and surgical resection; radiotherapy is not effective as osteosarcomas are relatively radioresistant. Prognostic factors include metastases at presentation, histologic response to induction chemotherapy, the site of the primary tumor (with axial lesions having an inferior outcome), serum lactate dehydrogenase and alkaline phosphatase levels.
Topics: Antineoplastic Combined Chemotherapy Protocols; Biopsy; Bone Neoplasms; Chemotherapy, Adjuvant; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Neoadjuvant Therapy; Neoplasm Staging; Orthopedic Procedures; Osteosarcoma; Patient Care Team; Positron-Emission Tomography; Prognosis; Radiography; Plastic Surgery Procedures; Tomography, X-Ray Computed
PubMed: 29182106
DOI: No ID Found -
JAAPA : Official Journal of the... Aug 2018This article reviews the cause, clinical presentation, diagnostic methods, and management of osteosarcoma, the most common primary bone tumor and third most common... (Review)
Review
This article reviews the cause, clinical presentation, diagnostic methods, and management of osteosarcoma, the most common primary bone tumor and third most common cancer among children and adolescents. In the 1970s, the introduction of adjuvant chemotherapy following tumor resection improved overall 10-year survival from 30% to about 50% of patients. However, since that change in management strategy, the survival rate has since plateaued, with no improvement in overall 10-year survival since the 1990s. A better understanding of this disease is the first step to help improve these numbers.
Topics: Bone Neoplasms; Chemotherapy, Adjuvant; Humans; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Osteosarcoma
PubMed: 29979330
DOI: 10.1097/01.JAA.0000541477.24116.8d