Treatment of Localized Osteosarcoma and UPS of Bone

Patients with localized osteosarcoma who undergo surgery and chemotherapy have a 5-year overall survival (OS) rate of 62% to 65%.[1] Complete surgical resection is crucial for patients with localized osteosarcoma, but it is not sufficient as the only therapy. At least 80% of patients treated with surgery alone will develop metastatic disease.[2] Randomized clinical trials have established that adjuvant chemotherapy is effective in preventing relapse or recurrence in patients with localized resectable primary tumors.[2]; [3][Level of evidence A1]

Undifferentiated pleomorphic sarcoma (UPS) of bone is seen more commonly in older adults. Patients with UPS of bone are treated according to osteosarcoma treatment protocols. The outcome for patients with resectable UPS is similar to the outcome for patients with osteosarcoma.[4] As with osteosarcoma, patients with favorable necrosis (≥90% necrosis) have a longer survival than do those with an inferior necrosis (<90% necrosis).[5] Many patients with UPS will need preoperative chemotherapy to achieve a wide local excision.[6]