Treatment of Bone Cancer Requires a Multidisciplinary Team
Bone cancer should be managed by a multidisciplinary team of specialists with demonstrated expertise in bone tumors, including at minimum an orthopedic oncologist, bone pathologist, medical/pediatric oncologist, radiation oncologist, and musculoskeletal radiologist. 1
Core Multidisciplinary Team Members
The evaluation and treatment of bone cancer patients requires a comprehensive team approach that includes:
- Orthopedic oncologist: Performs biopsies and surgical resections
- Bone pathologist: Specializes in diagnosing bone tumors
- Medical/pediatric oncologist: Manages chemotherapy regimens
- Radiation oncologist: Administers radiation therapy when indicated
- Musculoskeletal radiologist: Interprets specialized imaging studies 1
Additional specialists who may be critical in certain cases include:
- Thoracic surgeon
- Plastic surgeon
- Interventional radiologist
- Physiatrist
- Vascular/general surgeon
- Neurosurgeon/orthopedic spine surgeon
- Palliative care physician 1
Importance of Specialized Care
The rarity of bone cancer (fewer than 0.2% of all cancers) necessitates management by specialists with specific expertise in these tumors 1. Primary bone cancers demonstrate wide clinical heterogeneity, with osteosarcoma (35%), chondrosarcoma (30%), and Ewing sarcoma (16%) being the most common forms 1.
Critical Aspects of Bone Cancer Management
Biopsy Considerations
Biopsy is a critical step that should be performed at the center that will provide definitive treatment:
- Biopsy placement is crucial for future limb-salvage techniques
- Should be performed by a senior surgeon with oncologic expertise
- Core needle or surgical biopsy techniques may be used
- Inappropriate biopsy can compromise functional and survival outcomes 2
Treatment Approach
The multidisciplinary team collaborates to develop a comprehensive treatment plan that may include:
- Surgical resection with negative margins
- Neoadjuvant and adjuvant chemotherapy (for osteosarcoma and Ewing sarcoma)
- Radiation therapy when indicated
- Limb-sparing approaches when possible 1, 3
Long-term Follow-up
Long-term surveillance and follow-up are necessary to:
- Monitor for disease recurrence
- Manage treatment-related comorbidities from surgery, chemotherapy, and radiation
- Address potential late effects in long-term survivors 1
Common Pitfalls to Avoid
Delayed referral: Patients with aggressive, painful bone lesions (especially those under 40 years) should be promptly referred to an orthopedic oncologist before further workup 1
Inappropriate biopsy: Biopsy performed without consideration of the definitive surgical approach can compromise limb-salvage options 2
Fragmented care: Treatment by physicians without specific expertise in bone tumors can lead to suboptimal outcomes 1, 4
With current multimodality treatment approaches delivered by specialized teams, survival rates have significantly improved. Approximately 60-70% of patients with localized osteosarcoma are now cured, and 90% can be treated with limb-sparing approaches 1.