Bone tumours (osteosarcoma and chondrosarcoma)

Under 0.2% of cancers; 60% at 10–20 years; 80% in long bones; lung metastases common.
Investigations: FBC, RFT, LFT, LDH, ALP, ESR; X-ray; CT and MRI of the primary and chest; bone scan; PET/CT; core or incisional biopsy.
Limb-sparing strategies are preferred (neoadjuvant chemotherapy, RT and surgery) with orthopaedic input.

Tumour	Treatment	Radiotherapy dose
Osteosarcoma	Wide excision or amputation vs limb-sparing surgery; resection of lung metastases; neoadjuvant chemotherapy for high-grade or metastatic disease	Post-op R0 55–60 Gy, R1 64–66 Gy, R2 68–70 Gy; unresectable 60–70 Gy
Chondrosarcoma	Wide excision; RT for inadequate margins or palliation	Post-op 60–70 Gy; unresectable >70 Gy
Chordoma	Wide or en bloc resection then RT	66–70 Gy

Osteosarcoma chemotherapy (every 3 weeks)

First line: S: doxorubicin 25 mg/m²/day IV days 1–3 + cisplatin 75 mg/m² IV day 1 × 6 cycles, OR ifosfamide 1.3 g/m² days 1–3 + doxorubicin 50 mg/m² day 1 + cisplatin 100 mg/m² over days 1–3 × 6 cycles.
Second line: gemcitabine 675 mg/m² days 1 and 8 + docetaxel 75–100 mg/m² day 8 × 4–6, OR carboplatin 400 mg/m²/day days 1–2 + ifosfamide 1,800 mg/m²/day days 1–3 (with mesna) + etoposide 100 mg/m²/day days 1–3.
Follow up every 3–6 months with chest imaging for 5 years, then yearly to 10 years.

Imeandikwa:

18 Oktoba 2026, 21:05:21

References:

Ministry of Health, United Republic of Tanzania. Standard Treatment Guidelines and National Essential Medicines List for Tanzania Mainland (STG & NEMLIT). 7th ed. Dodoma: Ministry of Health; 2026. Chapter 22, Malignant Disease Conditions: section 22.11.1 Bone tumors, pp. 625–626.