Osteosarcoma in children: from etiology to treatment

Keywords

osteossarcoma - pediatric - treatment

Introduction: Osteosarcoma is the most common bone tumor in children and adolescents, typically occurring during growth. It mainly affects the knee joint but can also involve the femur and tibia. Its development is influenced by programmed cell death mechanisms. Symptoms include pain, swelling, and fractures, leading to systemic issues such as weight loss and anemia. Biopsy is the most accurate diagnostic and therapeutic tool. Osteosarcoma is a primary neoplasm, rare in soft tissues, with a metastasis rate over 85%, potentially affecting the lungs, liver, and brain. Early diagnosis and treatment are crucial, highlighting the need for studies on its nature and therapy.

Methodology: This integrative literature review searched PubMed and BVS databases for articles using “osteosarcoma,” “pediatric,” and “treatment” from 2019 to 2024. Sixteen articles were found, with thirteen included in the study.

Results: Pathophysiology remains unclear, but dysfunctional apoptotic pathways are linked to development (n = 2), with therapeutic approaches targeting these pathways being promising. Accelerated bone growth in adolescents (n = 1) and high birth weight (n = 2) are associated with higher neoplastic risk. Poor prognosis correlates with lactate dehydrogenase >1000 IU/ml, necrosis index <90, and metastasis, mainly pulmonary (n = 2). Recommended treatments include tumor removal surgery, radiotherapy, and multi-agent chemotherapy, with adjuvant chemotherapy improving survival compared to surgery alone. Medical failures, unclear signs, and delays, especially in Brazil, worsen prognosis. A study found that 50% of patients end with amputation.

Conclusion: Osteosarcoma is aggressive and requires early diagnosis for better prognosis. Investigate bone pain, swelling, and functional limitations with radiological exams. Biopsy should follow detailed evaluation in uncertain cases. Multimodal treatment with neoadjuvant chemotherapy, limb-sparing resection, and radiotherapy offers the best cure chances, especially in specialized centers. The lack of precise biomarkers highlights the need for further research to develop effective classification systems and new agents. Advancements in diagnosis and treatment are essential for improving outcomes.

Corresponding author: Julia Isume (e-mail: [e-mail]).