Osteosarcoma - Treatment

Based therapy is surgical removal of malignant lesions. Limb preservation is most commonly used to treat these patients.Chemotherapy is also required to treat metastatic disease, which is present at diagnosis but often undetectable.
Preoperativa therapy-chemotherapy:Chemotherapy is critical for patients with osteosarcoma. This not only facilitates tumor reduction but decreases the risk of metastasis. Patients who had a good histologic response to chemotherapy, destroyed over 90% of tumor have a better prognosis than those of coror tumors do not respond.Osteosarcoma is resistant to radiation, so it is not included in standard therapy regimens.Most active chemotherapy in osteosarcoma are doxorubicin, cisplatin and methotrexate. Emesis is a significant adverse clinical effect of chemotherapy, especially those for treating osteosarcoma. Patients requiring antiemetic: anatgonistii serotonin receptor: ondasetron, corticosteroids: dexamethasone and dopamine receptor antagonists: metoclopramide.Colony stimulating factors are agents that act as haematopoietic growth factors that stimulate the growth of granulocytes. They are used to treat or prevent neutropenia in a patient receiving myelosuppressive chemotherapy and to reduce the period of neutropenia associated with bone marrow transplantation.Antidotes are agents used to control a poisoning or overdose, prevent or treat the toxic effects of metabolic disorders.Mechanisms of action vary and include anatagonismul, toxin transformation, altered metabolism, chelation and directed antibody response: leucovorin, mesna.
Surgical therapy:Because osteosarcoma unresponsive to radiotherapy, surgery is the only option for permanent and total tumor removal. May order partial or total joint prosthesis or bone reconstruction.Biopsy:Biopsy procedures include open biopsy, preferred to avoid sampling errors, or very fine needle biopsy of choice for vertebral bodies and pelvic lesions or fine-needle aspiration-not recommended.Final resection:Patient wants definitive resection survival as tumor margins must contain normal tissue. Thickness is only important for bone edges.Radical involves removal of the affected compartment edges: joint, bone, muscle, entirely. Amputation may be an option in some circumstances. There are several options for reconstruction and limb salvage.In the practice of grafting limb reconstruction:Autologous bone-graft-vascularized or not, appears to reject the graft, and infection rate is lowAllogrefele shows higher-grade infection and poor wound healing, especially in chemotherapy, can occur immunologically rejectJoint reconstruction, prosthesis, can be solitary or expandable, the longevity of such transplants for children is a problemRotatioplazia-is-a technique for patients with tumors of the distal femur and proximal tibia, especially large ones that amputation extreme is the option chosen. After tumor resection is performed to repair vessels head-to-end anastomosis. Distal portion of the leg is rotated 180 degrees and reattached to the thigh and proximal resection edge.
Resection of pulmonary nodules:Metastatic lung nodules can be treated by complete resection.Pneumectomia lobar resection or free edges may be required.This procedure must be performed at the time of resection of bone. Bilateral Toracotomiile indicated in bilateral metastases. For osteosarcoma which is a lung lesion or more just one year after completion of therapy, only surgical resection can be curative.Chemotherapy is recommended if the applicant is leaving because the risk of metastasis is high.
Complications of therapy:Deafness is a adevrs effect of cisplatin. Fever and neutropenia may occur and indicate intravenous antibiotics and monitoring.Other diseases that may complicate the patient's condition include: chicken pox infection, mucositis, dehydration, meningitis, constipation, fungal pneumonia and cystitis. Cardiomyopathy is the result of anthracycline therapy. Infertility is a universal effect alkilanti agents in high doses.Monitoring tumor appellant:After completion of chemotherapy patients should be submitted regularly to the doctor to perform X-rays and laboratory tests.These visits are conducted at ach three months for the first year, every 6 months for the second year and then once a year.Survivors after 5 years are considered long term.