Osteosarcoma (Bone Cancer) Symptoms, Stages and Treatment
In this article
What Is Osteosarcoma (Bone Cancer)?
Osteosarcoma arises from bone-forming cells (osteoblasts) and is the most common primary bone cancer (originating directly in bone rather than spreading from another organ). It is the most common bone tumour during adolescence and tends to occur at the ends of rapidly growing long bones (around the knee, hip or shoulder). It requires a multidisciplinary approach, combining surgery and chemotherapy in a "sandwich" pattern before and after surgery. Although chemotherapy protocol advances over the past 40 years have markedly improved survival, osteosarcoma remains a difficult cancer resistant to many modern targeted therapies and immunotherapies. This guide comprehensively covers the entire process, from causes to current treatment approaches.
Osteosarcoma is one of the two most common primary bone cancers in childhood/adolescence; the other is Ewing sarcoma. They arise from different cells, produce different imaging findings (Ewing sarcoma generally starts in the bone shaft, the "diaphysis") and use different chemotherapy protocols (VAC-IE for Ewing sarcoma). This guide focuses specifically on osteosarcoma; for detailed Ewing sarcoma information, see our article on Ewing sarcoma on our website.
How Common Is It? (Current Statistics)
According to the American Cancer Society (ACS), approximately 1.000 new osteosarcoma cases are diagnosed annually in the US, about half in children and adolescents; osteosarcoma accounts for approximately %2-3 of childhood cancers (ACS "Key Statistics for Osteosarcoma", last updated 21 August 2025). In SEER's broad "bone and joint cancers" category (2018-2022 data, published in 2025-2026), annual incidence is 1,0 per 100.000, and 5-year relative survival is approximately %70,7(2015-2021 SEER-21 cohort). According to a classic SEER analysis (Ottaviani G, Jaffe N, Cancer Treatment and Research, 2009; 1973-2004 data), incidence is 5,4 per 100.000 in men and 4,0 per 100.000 in women — the commonest sites are the femur (%42, mainly distal), tibia (%19, mainly proximal) and humerus (%10, mainly proximal). The tumour arises in the fastest-growing "growth plate" regions, most frequently around the knee .
Osteosarcoma incidence has two distinct age peaks: the dominant peak in adolescence (age 10-19, coinciding with the growth spurt — rapidly proliferating osteoblasts are thought more susceptible to cancer then), and a smaller second peak above age 60-65 (ACS reports approximately %20 of all osteosarcomas above age 60). This second group differs biologically: rather than spontaneous de novo disease in growing bone, it mainly consists of "secondary osteosarcoma" arising from Paget's disease of bone or previous radiotherapy .
No Türkiye-specific national incidence figure was found in this research (the Turkish Pediatric Oncology Group/Turkish Pediatric Hematology Association registry does not publish a separate osteosarcoma incidence figure). However, according to a single-centre Turkish study (Altıntaş M, et al., Turkish Archives of Pediatrics, 2024; 59 paediatric patients during 2007-2021), %59,3 already had metastatic disease at diagnosis; 5-year overall survival was %47,5 and disease-free survival %30,5. These figures are markedly worse than US/SEER-based data — probably reflecting diagnostic delay and single-centre/referral population bias; they should be considered an example of the real-world clinical picture rather than national incidence.
Hereditary Predisposition and Risk Factors
Most osteosarcomas occur sporadically (nonhereditarily); however, several important hereditary syndromes and acquired conditions markedly increase risk:
| Condition | Gene/Cause | Risk Data |
|---|---|---|
| Li-Fraumeni syndrome | TP53 germline mutation | Cumulative osteosarcoma risk by age 70: %11 in men, %5 in women — one of the 3 most common cancers in male carriers (Mai PL, et al., Cancer, 2016) |
| Hereditary retinoblastoma | RB1 germline mutation | Markedly increased risk even without irradiation; approximately 400-fold risk in irradiated areas; cumulative bone sarcoma incidence may reach %7 at 20 years after irradiation (Kleinerman RA, et al., Clinical Sarcoma Research, 2012) |
| Rothmund-Thomson syndrome (Type 2) | RECQL4 mutation | One study showed that all RTS patients developing osteosarcoma (11/11) carried a truncating RECQL4 mutation (Wang LL, et al., J Natl Cancer Inst, 2003) |
| Werner syndrome | WRN mutation | Osteosarcoma constitutes %7 of syndrome-associated cancers; may occur atypically in adulthood (35-57) and at atypical sites (foot/ankle) |
| Bloom syndrome | BLM mutation | Osteosarcoma is a rare but recognised component of the syndrome's cancer spectrum |
| Paget's disease of bone | Acquired (in older age) | A recognised background for secondary osteosarcoma in older adults; primary-source verification is recommended for exact rates, but it is considered a rare complication |
| Previous radiotherapy | Acquired | A recognised risk factor for secondary osteosarcoma; latency between irradiation and tumour development is generally around 10-20 years (average ~12 years in retinoblastoma cohorts) |
Histological Subtypes and Molecular Features
Conventional (classic) osteosarcoma, accounts for approximately %80 of all osteosarcomas and is divided into three types according to the predominant matrix: osteoblastic (~%50), chondroblastic (~%25) and fibroblastic (~%25) (Kundu ZS, Indian Journal of Orthopaedics, 2014). There are also much rarer subtypes with different clinical behavior:
| Subtype | Frequency | Clinical Behavior |
|---|---|---|
| Telangiectatic osteosarcoma | <%4 | Mimics an aneurysmal bone cyst (blood-filled cystic spaces) |
| Small cell osteosarcoma | Rare | May mimic Ewing sarcoma; aggressive course, ~%30 5-year survival, poor response to chemotherapy |
| Low-grade central osteosarcoma | %1-2 | In the 3rd-4th decades, slow-growing, may mimic fibrous dysplasia; relatively favorable prognosis compared with conventional osteosarcoma |
| Parosteal osteosarcoma | Rare, relatively common in young women | Arises from the bone surface (periosteum), heavily ossified; ~%90 5-year survival (except with inadequate surgical margins or high-grade dedifferentiation) |
| Periosteal osteosarcoma | Rare | Low-grade, slow-growing; ~%91 5-year survival (with surgery alone) |
| High-grade surface osteosarcoma | <%1 | Despite arising from the surface, behaves aggressively like conventional high-grade disease — unlike other surface types, its prognosis is limited |
According to a comprehensive whole-genome sequencing study (Chen X, et al., Cell Reports, 2014), in pediatric osteosarcoma samples, TP53 gene alterations in %90 were identified, and %55 of these alterations result from structural genomic rearrangements rather than classic point mutations. Alterations in the RB1 pathway have also been reported in %30-75 of sporadic osteosarcomas. In contrast, MDM2/CDK4 gene amplification is generally absent in conventional high-grade osteosarcoma; instead, it is specifically in low-grade central osteosarcoma and parosteal osteosarcoma that it occurs, and it is used diagnostically in the pathology laboratory to distinguish these tumors from benign fibro-osseous lesions (for example, fibrous dysplasia).
Symptoms
- Pain in the affected bone, often worsening at night or with activity
- Swelling or a palpable mass
- Limited joint movement (if near a joint)
- A fracture more severe than expected after minor trauma (pathological fracture — present at diagnosis in approximately %10 of patients)
- Limping (with lower extremity involvement)
- Systemic symptoms such as fever and night sweats are rare
Because these symptoms can be confused with "growing pains," particularly in growing children and adolescents, diagnosis may sometimes be delayed; bone pain lasting more than two weeks, worsening at night or disproportionately severe for the trauma should always be evaluated.
How Is It Diagnosed?
Imaging
Plain radiography (X-ray)is the first-line imaging method; classic findings of osteosarcoma include the "sunburst" appearance (needle-like bone formation due to an aggressive periosteal reaction) and Codman's triangle (a triangular shadow where the elevated/interrupted periosteum meets the normal cortex — a finding most classically associated with osteosarcoma that may also occur in Ewing sarcoma).
| Method | Purpose |
|---|---|
| MRI (magnetic resonance imaging) | Local staging — assessing soft tissue spread, joint/neurovascular involvement and "skip" metastases; should include the entire bone of origin and adjacent joints |
| Chest CT | The standard method for screening the lungs, the most common site of metastasis |
| Bone scintigraphy and/or FDG-PET/CT | Additional skeletal staging — identifying bone metastases/skip lesions; PET/CT is also increasingly used to assess treatment response |
Needle (core) biopsy is preferred over open biopsy when possible (lower risk of contamination). However, the most critical point is this: the biopsy should be planned in direct coordination with the surgeon who will perform the definitive surgery, preferably at the same center — because the biopsy tract should be selected along the planned definitive surgical resection line so that it can be completely removed together with the tumor. A poorly planned or incorrectly located biopsy can contaminate surrounding tissues, eliminate the chance of limb-sparing surgery and worsen outcomes — therefore, the decision to biopsy a suspicious bone lesion should be made after referral to an experienced bone and soft tissue tumor center.
Staging
In bone sarcomas, unlike many other cancers, both the classic surgical Enneking (MSTS) staging system and the AJCC TNM system are used in clinical practice. While the AJCC 8th edition uses the table below for the bones of the extremities/trunk/skull and face, separate staging systems that are not based on size have been defined for bone sarcomas located in the spine and pelvis (Tanaka K, Ozaki T, Japanese Journal of Clinical Oncology, 2019) — this guide uses the extremity/trunk table, where the vast majority of osteosarcomas are located.
Enneking (MSTS) Surgical Staging System
| Stage | Grade (G) | Local Extent (T) | Metastasis (M) |
|---|---|---|---|
| IA | G1 (low-grade) | T1 (intracompartmental) | M0 |
| IB | G1 (low-grade) | T2 (extracompartmental) | M0 |
| IIA | G2 (high-grade) | T1 (intracompartmental) | M0 |
| IIB | G2 (high-grade) | T2 (extracompartmental) | M0 |
| III | Any | Any | M1 (regional or distant metastasis) |
Here, "intracompartmental (T1)" means that the tumor remains confined by a natural anatomical barrier such as cortical bone, the joint capsule or a major fascial septum, whereas "extracompartmental (T2)" means that the tumor has crossed this barrier and spread into surrounding tissue. This system was defined in 1980 (Enneking WF, et al., Clinical Orthopaedics and Related Research, 1980) and is still widely used by orthopedic oncologists.
AJCC 8th Edition TNM System (Extremity/Trunk Bone Sarcomas)
| Stage | T | N | M | Grade |
|---|---|---|---|---|
| IA | T1 (≤8 cm) | N0 | M0 | G1/GX (low) |
| IB | T2-T3 (>8 cm or skip lesion) | N0 | M0 | G1/GX (low) |
| IIA | T1 (≤8 cm) | N0 | M0 | G2-G3 (high) |
| IIB | T2 (>8 cm) | N0 | M0 | G2-G3 (high) |
| III | T3 (skip lesion) | N0 | M0 | G2-G3 (high) |
| IVA | Any | N0 | M1a (lungs only) | Any |
| IVB | Any | N1 (any N) | M1b (other distant sites) or any M with N1 | Any |
Regional lymph node involvement (N1) is very rare in bone sarcomas; when present, it is considered prognostically equivalent to distant metastasis.
Treatment Approach: The "Sandwich" Model
Standard treatment for localized, high-grade osteosarcoma is based on a three-stage "sandwich" approach: (1) neoadjuvant (preoperative) chemotherapy → (2) surgical resection → (3) adjuvant (postoperative) chemotherapy. The rationale for this approach is both to treat possible microscopic metastases early and to increase the chance of limb-sparing surgery by shrinking the tumor before surgery.
Neoadjuvant/Adjuvant Chemotherapy: The MAP Regimen
The standard chemotherapy backbone in high-grade osteosarcoma is the methotrexate (high-dose) + doxorubicin + cisplatin (MAP) combination. This regimen was developed and established as standard through numerous cooperative group studies (COSS, POG/COG, SSG, EOI) from the 1980s to the 2000s.
Measured in the surgical specimen after neoadjuvant chemotherapy, the percentage of tumor necrosis is one of the strongest prognostic factors: Grade I (%0-50 necrosis) and Grade II (%51-89 necrosis) are classified as a "poor response"; Grade III (%90-99 necrosis) and Grade IV (%100 necrosis) as a "good response" (Huvos AG, et al., Archives of Pathology & Laboratory Medicine, 1977). ≥%90 necrosis ("good response") was also the threshold underlying the randomization design of the EURAMOS-1 study described below.
In patients with a poor response (MAP vs MAPIE): 618 patients with a poor response were randomized to continue MAP or add ifosfamide+etoposide to MAP (MAPIE); no significant difference in event-free survival was found (HR 0,98), and toxicity was markedly higher in the MAPIE arm (febrile neutropenia %73 versus %50) (Marina NM, et al., Lancet Oncology, 2016). In patients with a good response (MAP vs MAP+interferon): Adding pegylated interferon alfa-2b maintenance therapy to MAP also did not produce a significant difference in 3-year event-free survival (HR 0,83; p=0,214); moreover, only %76 of patients could start interferon, and a substantial proportion stopped early due to toxicity (Bielack SS, et al., Journal of Clinical Oncology, 2015). These results showed that additional intensification of the MAP regimen (at least with these two strategies) did not improve outcomes and instead increased toxicity — this finding was also recently confirmed by an independent Japanese study (JCOG0905, Journal of Clinical Oncology, 2025).
Surgical Treatment
Before the 1970s, amputation was the standard treatment; with the development of effective chemotherapy and advances in imaging/reconstruction techniques, for extremity osteosarcomas without major neurovascular involvement today, limb-sparing surgery has become the predominant approach at experienced centers. According to a systematic review/meta-analysis, in the modern chemotherapy era, limb-sparing surgery has been associated with at least equivalent (and in some analyses better) 5-year survival compared with amputation — this difference is thought largely to reflect patient selection criteria (amputation is preferred in more locally advanced disease).
According to a study (Li X, et al., International Orthopaedics, 2012), the local recurrence rate is %8,3 with wide surgical margins and %10,7 with close margins, whereas with positive surgical margins, it rises to %57,1 — thus, while the difference between wide and close margins is not statistically significant, avoiding positive margins is of decisive importance.
- Reconstruction with an endoprosthesis: replacing the resected bone/joint region with a metal implant
- Expandable endoprostheses: special implants that can be lengthened in parallel with bone growth in children who have not reached skeletal maturity — although effective, they have been reported to require an average of approximately 9 additional surgical procedures during the growth period (Dotan A, et al., Journal of Children's Orthopaedics, 2010)
- Rotationplasty: a special reconstruction technique, particularly in very young/skeletally immature children, in which the ankle is reversed and repositioned to function as the knee joint; long-term functional outcomes and quality of life were found to be close to those of the general population, and the vast majority of patients stated that they would choose the same procedure if given the choice again (Gradl G, et al., BMC Musculoskeletal Disorders, 2015)
- Amputation: may still be necessary in circumstances such as extensive involvement of neurovascular structures
According to a recent systematic review/meta-analysis (Wei Q, et al., World Journal of Surgical Oncology, 2026), in recurrences limited to the lungs, surgical metastasectomy has been associated with markedly better survival compared with patients who did not undergo surgery; the strongest favorable prognostic factor is complete (R0) resection being achieved. In disease with a single nodule, 5-year survival can reach %50. Therefore, pulmonary metastasectomy is considered part of the standard treatment approach for surgically resectable recurrences/metastases limited to the lungs.
Mifamurtide (Mepact): Approved in Europe, Not Approved in the US
Mifamurtide (liposomal muramyl tripeptide-phosphatidylethanolamine, MTP-PE) is the only approved immunotherapeutic agent specific to osteosarcoma, exerting an immunomodulatory effect by activating macrophages/monocytes. The story of this drug provides an interesting example of European and US regulatory agencies evaluating the same dataset differently.
According to the Children's Oncology Group INT-0133 study (Meyers PA, et al., Journal of Clinical Oncology, 2008; 678 patients, aged 1-31), adding mifamurtide to chemotherapy increased 6-year overall survival from %70 to %78 (approximately %28 relative reduction in the risk of death). Based on these data, mifamurtide received approval on 6 March 2009 in Europe (EMA) for the indication "in children, adolescents and young adults aged 2-30 with macroscopically completely resected, non-metastatic, high-grade osteosarcoma, in combination with multi-agent chemotherapy."
The application based on the same data met a different outcome in the US: on 9 May 2007, the FDA's Oncologic Drugs Advisory Committee (ODAC), due to statistical concerns about the study design (the primary endpoint having been changed during the study), voted 12 to 2 against approval , and the FDA sent an official "Not Approvable" letter on 27 August 2007. As of the date of this research (August 2026), no record could be found of a new application by the manufacturer or a change in the FDA's decision — mifamurtide is still not an approved drug in the US.
According to a joint analysis by the Italian and Spanish Sarcoma Groups (Palmerini E, et al., Journal of Clinical Oncology, published on 29 August 2025; 398 patients), mifamurtide showed a marked benefit particularly in P-glycoprotein (Pgp)-positive (relatively chemotherapy-resistant) tumors: 5-year event-free survival was %71,4 versus %58,3 (p=0,01), and 5-year overall survival was %75,4 versus %65,8 (p=0,01). This finding indicates a current, active area of discussion regarding which patient subgroup benefits most from mifamurtide; the EMA label does not yet require Pgp testing.
Treatment for Recurrent or Resistant Disease
The main regimens used in recurrent/resistant osteosarcoma include gemcitabine + docetaxel (objective response rate of %29 in one study; Navid F, et al., Cancer, 2008) and ifosfamide + etoposide or high-dose ifosfamide monotherapy. Response rates with these regimens are generally modest because recurrent disease may have become relatively resistant to first-line drugs.
Unlike many cancer types, osteosarcoma is considered an "immunologically cold" tumor that generally responds poorly to immune checkpoint inhibitors. In the SARC028 study (Tawbi HA, et al., Lancet Oncology, 2017), only 1 of 22 patients with osteosarcoma (%5) responded to pembrolizumab monotherapy — far below the response rates seen in tumors such as melanoma or non-small cell lung cancer. Therefore, immunotherapy in osteosarcoma remains an active research area rather than a currently proven standard treatment.
In the CABONE study (Italiano A, et al., Lancet Oncology, published on 17 February 2020), in patients with advanced osteosarcoma, the objective response rate with cabozantinib was %12 and median progression-free survival was 6,7 months — an unusually real (but modest) signal for osteosarcoma. This finding led to the randomized AOST2032 study (Children's Oncology Group) testing the addition of cabozantinib to MAP chemotherapy, and this study continues to enroll patients as of 2026. Cabozantinib is not an FDA/EMA-approved treatment for osteosarcoma as of the date of this research — its use is currently based on research/a single-arm phase 2 signal, and randomized confirmation is still awaited.
Osteosarcoma expresses the GD2 ganglioside, which is also targeted in neuroblastoma; based on this shared biology, several early-phase clinical trials investigating GD2-directed CAR-T cell therapies (for example, the "GD2-CAR PERSIST" study) also include osteosarcoma cohorts. However, as of the date of this research, there is no approved or completed pivotal GD2-directed treatment specific to osteosarcoma — these approaches remain at an early/research stage.
Denosumab (a monoclonal antibody targeting RANKL) is FDA/EMA-approved for giant cell tumor of bone (GCTB) — however, this is a separate disease entirely different from osteosarcoma, generally benign but locally aggressive, and associated with the H3F3A G34W mutation. Denosumab is not a standard or investigational systemic treatment for conventional osteosarcoma; in pathology practice, it comes up only in the differential diagnosis of a separate, rare entity called "giant cell-rich osteosarcoma," which can histologically mimic GCTB. It is important not to confuse these two different "giant cell" bone diseases.
Side Effects
- High-dose methotrexate: kidney toxicity (managed with leucovorin rescue therapy and hydration), mucositis
- Doxorubicin: cardiac toxicity (related to cumulative dose, requires long-term follow-up), myelosuppression, hair loss
- Cisplatin: hearing loss (ototoxicity — an important long-term problem, particularly in children), kidney toxicity, nausea
- Ifosfamide: hemorrhagic cystitis (prevented with mesna), neurotoxicity, renal tubular dysfunction
- Mifamurtide: infusion-related symptoms such as chills, fever and tachycardia (due to cytokine release)
- Related to surgery/endoprostheses: infection, mechanical loosening/breakage, leg length discrepancy (with expandable prostheses)
Global Approval and Evidence History
Unlike many other cancer types, osteosarcoma has seen very few new drug approvals in the last 40 years — the main treatment is still MAP chemotherapy, which took shape in the 1980s. Therefore, the timeline below includes both official approvals and key studies that shaped treatment practice (with their nature clearly stated).
Following ODAC's negative 12-2 vote; mifamurtide has never been approved in the US since that date.
Based on the INT-0133 study; the only approved immunotherapeutic agent specific to osteosarcoma.
Adding pegylated interferon to MAP was shown to provide no benefit (Bielack, JCO 2015).
MAPIE (adding ifosfamide+etoposide) was shown not to improve outcomes and to increase toxicity (Marina, Lancet Oncology 2016) — a practice-changing finding that prevents unnecessary intensification.
A %12 response rate in advanced osteosarcoma; led to the randomized AOST2032 study.
The Japanese study independently confirmed the ifosfamide intensification finding of EURAMOS-1.
Analysis by the Italian/Spanish Sarcoma Groups (ISG/OS-2, GEIS-33); initiated the current discussion about which patients benefit most from mifamurtide.
The randomized phase 2/3 study testing the addition of cabozantinib to MAP in newly diagnosed localized and metastatic osteosarcoma continues to enroll patients.
The Situation in Türkiye: TİTCK Authorization and SGK Reimbursement
Methotrexate, doxorubicin, cisplatin, ifosfamide and etoposide — all are drugs that have been authorized in Türkiye for many years, are manufactured as generics and are reimbursed by SGK. Under article 4.2.14.A of SUT (Health Implementation Communiqué), these drugs can be prescribed "without requiring conformity with the indication," based solely on a report by the relevant specialist documenting the treatment protocol — this means that there is no bureaucratic obstacle to the use of these drugs in standard oncology practice, including osteosarcoma.
Despite never having been approved in the US, mifamurtide (Mepact) in Türkiye is authorized and reimbursed by SGK — it was marketed by Takeda İlaç and, according to product information, was later acquired by Lucane Pharma. The conditions under SUT article 4.2.14.C largely correspond to the EMA label: ages 2-30, macroscopically completely resected, non-metastatic high-grade osteosarcoma, in combination with multi-agent chemotherapy, prescribed by a medical/pediatric oncology specialist based on a 1-year medical board report, with treatment stopped after a total of 48 infusions. Direct confirmation of these details in the current SUT text is recommended.
In Türkiye, children under 18 can access healthcare regardless of their own or their family's social security (SGK) status — this means that a child from an uninsured family is not deprived of osteosarcoma treatment. Pediatric oncology treatment in Türkiye is carried out in university/teaching hospitals under the coordination of the Turkish Pediatric Oncology Group (TPOG), in line with international protocols such as EURAMOS.
Follow-Up After Treatment and Long-Term Effects
After osteosarcoma treatment is completed, a structured follow-up program is implemented both to detect recurrence early and to manage the long-term effects of treatment. Because the vast majority of recurrences occur within the first 2-3 years, often in the lungs, the follow-up program focuses on this period — generally continuing with physical examination, imaging of the primary site (radiography/MRI) and chest CT every 2-3 months during the first 2 years, at gradually longer intervals in subsequent years.
Because most patients with osteosarcoma are children/adolescents/young adults, monitoring long-term effects after treatment is particularly important: doxorubicin-related cardiotoxicity (monitored with periodic echocardiography), cisplatin-related hearing loss (audiometric monitoring), monitoring kidney function, long-term functional/orthopedic follow-up in patients with expandable prostheses or rotationplasty, and — particularly in patients who previously received radiotherapy or have an inherited syndrome such as Li-Fraumeni — the risk of secondary cancer require long-term follow-up. Fertility (reproductive health) after childhood cancer is another important follow-up topic frequently raised by patients.
Frequently Asked Questions
- In which age group is osteosarcoma most common?
- It is most common during adolescence (ages 10-19), coinciding with the growth spurt. A smaller second peak occurs above age 60, generally as secondary osteosarcoma related to Paget's disease or previous radiotherapy.
- What is the difference between osteosarcoma and Ewing sarcoma?
- Both are primary bone cancers of childhood/adolescence, but they arise from different cells, have different imaging patterns (Ewing sarcoma more often starts in the bone shaft) and are treated with different chemotherapy protocols.
- Does every patient with osteosarcoma need an amputation?
- No. Today, limb-sparing surgery (with methods such as endoprostheses and rotationplasty) can be performed in many patients without major neurovascular involvement; amputation may be necessary only in selected cases with advanced local spread.
- Why is mifamurtide approved in Europe but not in the US?
- While the EMA considered the same clinical trial data sufficient and granted approval, the FDA's advisory committee voted against approval due to concerns about the study's statistical design — a rare but known example of two regulatory agencies evaluating the same data differently.
- Can osteosarcoma that has spread to the lungs (metastatic) be treated?
- In some patients with metastases limited to the lungs, long-term survival may be possible with surgical metastasectomy; outcomes are more favorable particularly in single-nodule disease where complete (R0) resection can be achieved.
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