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2017 ; 4
(1
): 25-43
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Osteosarcoma Overview
#MMPMID27933467
Lindsey BA
; Markel JE
; Kleinerman ES
Rheumatol Ther
2017[Jun]; 4
(1
): 25-43
PMID27933467
show ga
Osteosarcoma (OS) is the most common primary malignancy of bone and patients with
metastatic disease or recurrences continue to have very poor outcomes.
Unfortunately, little prognostic improvement has been generated from the last
20 years of research and a new perspective is warranted. OS is extremely
heterogeneous in both its origins and manifestations. Although multiple
associations have been made between the development of osteosarcoma and race,
gender, age, various genomic alterations, and exposure situations among others,
the etiology remains unclear and controversial. Noninvasive diagnostic methods
include serum markers like alkaline phosphatase and a growing variety of imaging
techniques including X-ray, computed tomography, magnetic resonance imaging, and
positron emission as well as combinations thereof. Still, biopsy and microscopic
examination are required to confirm the diagnosis and carry additional prognostic
implications such as subtype classification and histological response to
neoadjuvant chemotherapy. The current standard of care combines surgical and
chemotherapeutic techniques, with a multitude of experimental biologics and small
molecules currently in development and some in clinical trial phases. In this
review, in addition to summarizing the current understanding of OS etiology,
diagnostic methods, and the current standard of care, our group describes various
experimental therapeutics and provides evidence to encourage a potential paradigm
shift toward the introduction of immunomodulation, which may offer a more
comprehensive approach to battling cancer pleomorphism.