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Treatment Options for Bone Metastases With or Without Lung Metastases
Source: Osteosarcoma and Undifferentiated Pleomorphic Sarcoma of Bone Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: December 2, 2024 · Captured 2026-09-09.
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Context: Treatment of Osteosarcoma and UPS of Bone With Metastatic Disease at Diagnosis
The second most common site of metastasis is another bone that is distant from the primary tumor. Patients with metastasis to other bones distant from the primary tumor experience EFS and OS rates of approximately 10%.[1] In a study of patients who presented with primary extremity tumors and synchronous metastasis to other bones, only 3 of 46 patients remained continuously disease-free 5 years later.[12] Patients with transarticular skip lesions have a poor prognosis.[13]
Multifocal osteosarcoma is different from osteosarcoma that presents with a clearly delineated primary lesion and limited bone metastasis. Multifocal osteosarcoma classically presents with symmetrical, metaphyseal lesions, and it may be difficult to determine the primary lesion. Patients with multifocal bone disease at presentation have an extremely poor prognosis, but treatment with systemic chemotherapy and aggressive surgical resection may significantly prolong life.[14,15]
Treatment options for patients with bone metastases with or without lung metastases include the following:
Preoperative chemotherapy followed by surgery to remove the primary tumor. After definitive surgical resection of the primary tumor, most clinicians resume systemic chemotherapy.The timing of surgery to remove metastatic tumors is not well defined. It is usually not attempted at the time of primary surgery because delays of more than 21 days until resumption of chemotherapy can increase the risk of adverse events and death.[16]
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Surgery to remove the primary tumor followed by chemotherapy and then surgical resection of metastatic disease followed by postoperative combination chemotherapy. When the usual treatment course of preoperative chemotherapy followed by surgical ablation of the primary tumor and resection of all overt metastatic disease followed by postoperative combination chemotherapy cannot be used, an alternative treatment approach may be used. This alternative treatment approach begins with surgery for the primary tumor, followed by chemotherapy, and then surgical resection of metastatic disease. This approach may be appropriate in patients with intractable pain, pathological fracture, or uncontrolled infection of the tumor when initiation of chemotherapy could create risk of sepsis.[17]
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Resection of metastatic bone lesions if possible.
Radiation therapy to the extremities. There is evidence that radiation therapy to the extremities may offer some local control.[18]
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Preserved source evidence · Not medical advice