Treatment of Osteosarcoma in Germany
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Osteosarcoma (bone cancer) most often develops in teenagers and young adults. Most tumors arise in the knee or shoulder area. Osteosarcomas can be of high, medium or low grade of malignancy, which is taken into account when choosing a treatment regimen. The most common are aggressive high-grade tumors. Despite the severity of the disease, German doctors completely cure more than half of patients with osteosarcoma, and the rest achieve long-term remission. Attempts to cure cancer are made even at the advanced stage, and they are often successful. To undergo treatment in Germany, you should use the Booking Health service. On our website, you can compare the cost of treatment in Germany at different Cancer Centers in order to book an appointment at the hospital at the best price.
Content
- Principles of treatment
- Surgery
- Peculiarities of the treatment of bone cancer of different localization
- Treatment of cancer metastases
- Drug therapy
- Radiation therapy
Principles of treatment
Doctors try to perform osteosarcoma treatment with surgery, if possible. This is the only method that provides a complete cure from oncology.
In oncology, all cases of osteosarcoma are divided into three types:
- localized resectable tumor is located in one body region, and it can be removed completely;
- localized unresectable tumor, that cannot be completely removed, although it is located in one body region (for example, a critical organ is located nearby);
- metastatic osteosarcoma that has spread in the body (in some patients it is still considered resectable).
Surgery may be the first treatment for patients with localized resectable osteosarcomas. Then, other medical procedures are used, if required. However, in case of aggressive tumors, treatment often begins with chemotherapy. It lasts 10 weeks and is followed by surgery and another 12 months of chemotherapy.
If the tumor is unresectable, then treatment also begins with chemotherapy, even if it is non-aggressive. As a result, the tumor may shrink and become resectable. In such cases, radical surgery is performed for osteosarcoma treatment.
Even in advanced oncology, when metastases have appeared, the disease can still be cured. Doctors assess the resectability of metastases. If they can be removed, then a combined operation is performed in order to resect all tumor foci.
Surgery
Operations for osteosarcoma are carried out for the following purposes:
- to perform a biopsy – obtaining a tumor fragment for histological examination and confirmation of the diagnosis;
- for the treatment of osteosarcoma – the operation involves the total removal of the tumor, with the capture of normal tissues.
Preferably, the biopsy and surgery for cancer treatment should be performed consecutively by the same orthopedic surgeon. In this case, the physician can perform the biopsy in such a way that the following surgery is less traumatic and better functional result is obtained.
The following operations are performed in osteosarcoma:
Wide excision of the tumor is a surgical removal of osteosarcoma with the adjacent tissues. After surgery, the material is sent for histological examination. The main purpose of diagnostics is to examine the resection margin. If there are cancer cells at the border of the removed tissue, then it is necessary to additionally treat osteosarcoma with the help of a revision surgery or other methods. If the resection margins are negative, then this indicates a low risk of recurrence. Such patients may not require additional procedures for osteosarcoma treatment.
Amputation is very rarely used for the treatment of osteosarcoma in Germany. Doctors prefer to preserve limbs in order to avoid disability. Mutilating surgeries are performed only in extreme cases, when it is impossible to cure the disease in any other way. At the same time, in countries with poorly developed medicine, amputation still remains the main operation for the treatment of osteosarcoma, since this type of intervention is technically simpler.
Bone replacement is a stage of the limb preserving surgery. During a medical operation, the doctor removes a significant part of the bone that is affected by the tumor. A bone graft is implanted in its place – a bone is harvested from another part of the body, or an artificial prosthesis is used. Germany also applies an innovative approach in which doctors use both a patient's own bone and a prosthesis to reconstruct a limb.
Replacement surgery in children is of particular difficulty. This is because their bones grow. In such cases, it is necessary to carry out revision operations in a while, during which the prosthesis is replaced with a longer one. However, the problem is solved easier in Germany. German doctors implant innovative types of prostheses for children, the length of which can subsequently be adjusted without additional operations.
After an organ-preserving operation, a long-term rehabilitation of up to 1 year is required. However, the patient should not refuse it, otherwise the saved arm or leg may lose its function.
Arthrodesis is a fixed connection of two bones. This is necessary if cancer has appeared in the joint area. In this case, the joint must be removed completely. The remaining parts of the bones are joined together, and subsequently they are fused. The function of the limb is partially preserved, but its mobility is limited.
Peculiarities of the treatment of bone cancer of different localization
Bone cancer does not always develop in the limbs. Cancer of other localizations is more complex to treat. However, even in these cases, German doctors successfully cope with the disease. If bone cancer has developed beyond the limbs, German doctors carry out treatment of this disease with the following options:
Pelvic cancer. Treatment usually begins with chemotherapy. If the patient responds to it, and the cancer is treated efficiently, then an operation is performed. It is followed by radiation therapy. During surgery, it is often necessary to remove not only the pelvic bones, but also a part of the femur. Subsequently, doctors reconstruct the removed bones. If necessary, hip replacement is performed.
Jaw cancer. During the operation, the doctor can remove the entire lower jaw, and then restore it with an implant. A patient is treated surgically only if the entire tumor is expected to be removed. In other cases, radiation therapy is used.
Cancer of the spine and skull. These tumors are located close to the spinal cord or brain. As a result, their removal can be unsafe and in some cases impossible. To minimize the amount of tissues removed, doctors often begin treatment with chemotherapy. After the tumor is reduced, surgery is performed. If this is not possible, radiation therapy becomes the main option for cancer control.
Treatment of cancer metastases
In any type of oncology, distant metastases can appear, and bone cancer is not an exception. In Germany, even the presence of metastases is not a reason to abandon attempts to cure cancer. These patients undergo combined surgeries. Such interventions include the removal of the tumor and metastatic foci.
Osteosarcoma most often affects the lungs. When deciding on the necessity for a combined surgery, doctors take into account the number, location of metastases, their size, response to chemotherapy, as well as the general health condition of the person (whether he can undergo surgery).
A successful operation can be performed in Germany even if metastases have appeared in both lungs. They are removed during one surgical intervention, in good condition of the patient. If a person is debilitated by the disease, two operations can be carried out sequentially: first, metastases are removed from one lung, and then from the other one. To remove metastatic foci in Germany, not only traditional open interventions, but also minimally invasive video-assisted thoracoscopic surgeries through short incisions, are used. The best hospitals specializing in cancer therapy also perform robot-assisted interventions, which are considered the safest.
Much less often, metastases appear in the brain or liver. Sometimes they are also resectable, so a patient is treated surgically or with minimally invasive procedures. If these tumors cannot be removed, they are controlled by other methods: radiation therapy, drug therapy, ablation, chemoembolization, high-intensity focused ultrasound. In oncology, more and more methods are developed that allow doctors to safely destroy a tumor of any localization, and all of them are successfully used in Germany.
Drug therapy
Most osteosarcomas have a high degree of malignancy, so chemotherapy plays a huge role in the treatment of oncology. It is most often prescribed before a surgery, and then used even longer after a surgery. Doctors use high doses of drugs to increase the chances of curing the tumor. Since the majority of patients are young people, they successfully tolerate even aggressive chemotherapy regimens.
Other drugs are also used in the Departments of Oncology at the German clinics. Doctors prescribe targeted therapy with angiogenesis inhibitors. These drugs block the formation of new blood vessels needed to feed the tumor. They are used for advanced osteosarcoma, if conventional cytostatic chemotherapy no longer works.
Radiation therapy
Osteosarcoma is a radioresistant tumor. Until recently, radiation therapy has played a minimal role in the treatment of this disease. However, with the development of new irradiation methods that are used in Germany, radiation therapy has become more effective. Doctors can now target radiation more precisely, with minimal damage to healthy tissues. As a result, it became possible to increase the radiation dose and thus overcome the radioresistance of the tumor.
Doctors of Departments of Oncology use external beam radiation therapy in the following cases:
- impossibility of total surgical tumor removal;
- detection of the residual tumor after the surgical removal;
- advanced stages of cancer;
- recurrent tumors.
Radiotherapy cannot cure the disease completely, but it helps suppress tumor growth. In addition, radiation reduces symptoms, including bone pain and swelling, and reduces the risk of fractures.
Radionuclide therapy is used in Germany at the advanced stage of oncology. This is a type of systemic radiation therapy involving the administration of a radiopharmaceuticals intravenously. Radioactive substances accumulate in the bones and affect the tumor with radiation.
You are welcome to use the Booking Health services to find out prices and book an appointment for osteosarcoma treatment in Germany. Prices for you will be lower than if you contact the clinic directly. The cost of treatment in Germany will be decreased due to the exclusion of additional fees for foreign patients. The initial price will not increase, even if you need additional procedures that are not covered by the program. This is due to the fact that when you book a treatment through the Booking Health service, you will receive insurance that will cover all extra costs.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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