Comprehensive 2009 JAAOS review covering the epidemiology, subtype classification, staging workup, surgical options, chemotherapy protocols, and prognostic factors for osteosarcoma — the most common primary bone malignancy in children and adolescents.
When you encounter an adolescent with metaphyseal knee pain and an aggressive lytic-blastic lesion on radiograph, assume osteosarcoma until proven otherwise — initiate staging with MRI of the extremity and chest CT before biopsy, and plan the biopsy tract with the definitive resection in mind.
The Huvos 90% necrosis threshold at surgical resection directly drives your postoperative chemotherapy decision: good responders continue the same regimen; poor responders warrant a salvage attempt, though evidence that changing agents improves survival remains weak.
Comprehensive 2009 JAAOS review covering the epidemiology, subtype classification, staging workup, surgical options, chemotherapy protocols, and prognostic factors for osteosarcoma — the most common primary bone malignancy in children and adolescents.
When you encounter an adolescent with metaphyseal knee pain and an aggressive lytic-blastic lesion on radiograph, assume osteosarcoma until proven otherwise — initiate staging with MRI of the extremity and chest CT before biopsy, and plan the biopsy tract with the definitive resection in mind.
The Huvos 90% necrosis threshold at surgical resection directly drives your postoperative chemotherapy decision: good responders continue the same regimen; poor responders warrant a salvage attempt, though evidence that changing agents improves survival remains weak.