Introduction
Osteosarcoma, a kind of common bone cancer also known as osteogenic sarcoma, originates in mesenchymal tissue and is characterized to produce spindle-shaped stromal cells of bone-like tissue. Osteosarcoma commonly occurs at the metaphyseal segment of the limb long bones and the most common sites are distal femur, proximal tibia, and humerus, whereas flat bone is less involved. According to different histological types, osteo- sarcomas can be divided into osteoblastoma type, chondroblastoma type, myofibroblastoma type, small cell type, giant cell-rich type, and telangiectasia type. Prominent clinical manifestations of this disease are swelling, tenderness, and masses. Distant metastases are prone to occur in the early stage. The majority of patients already have the presence of tiny metastases when seeking medical services. Lung metastasis is the most common, followed by bone. Bone cancers are divided into primary and secondary categories. Almost all of the bone cancers are with hematogenous metastasis. Therefore, in most cases, only surgery combined with systemic chemotherapy treatment can cure primary bone cancers. Because most bone cancers are not sensitive to chemoradiotherapy, hyperthermia in combination with chemoradiotherapy as well as with integrative treatment is needed to improve the therapeutic effect. For secondary tumors, refer to the treatment protocol of the primary disease and add local hyperthermia at the metastatic sites and the corresponding anti–bone metastasis treatment.
Treatments
1. Surgery
Surgical resection is the primary means for the treatment of osteosarcomas. Amputation and disarticulation are the most common methods. However, with the progress of chemotherapy in recent years, some researchers have begun applying resection of tumor segment or total femur resection, with artificial prosthetic for replacement. Limb salvage has become a major operation. Conduct preoperative standardized chemotherapy for 6–8 weeks, and then implement tumor resection. Resection margin is required to be radical or extensive. Artificial joint replacement is commonly used for bone defects. If limb salvage is not suitable or in the case that there is no condition for limb salvage, amputation should be decisively implemented, but post- operative chemotherapy has to be applied. Chondrosarcoma treatment focuses on surgery, and the efficacy depends on the breadth of tumor resection and malignancy of histological grade. Ewing’s sarcoma is very sensitive to radiation and chemotherapy. In current treatment protocols, the most advocated is neoadjuvant chemotherapy combined with extensive or radical resection of tumor. The therapeutic principle of treatment for bone malignant fibrous histiocytoma is similar to that of osteosarcoma.
2.Radiotherapy
Radiotherapy can only be an adjuvant therapy for the treatment of bone cancers. Radiotherapy is ineffective for chondrosarcoma. Ewing’s sarcoma is sensitive to radiotherapy. For cases that are inoperable and surgery can only result in marginal or intralesional resection, radiotherapy and chemotherapy can be carried out.
3.Chemotherapy
Osteosarcoma chemotherapy focuses on following the principles of drug combination, neoadjuvant chemotherapy, and dose intensity. Chemotherapy is ineffective for chondrosarcomas. Ewing’s sarcoma is sensitive to chemotherapy, so chemotherapy and radiotherapy can be combined. Chemotherapy combined with surgery is mainly used for malignant fibrous histiocytoma of bone. Chemotherapy can be local or systemic chemotherapy. Local chemotherapy includes intraarterial infusion chemotherapy and regional perfusion, of which the regional perfusion effect is better.
4.Hyperthermia
For bone tumors, basic research and clinical practice have confirmed that, regardless of the heating mode, the clinical effects of hyperthermia are obvious. Methods of bone hyperthermia have been developed for preoperative/intraoperative hyperthermia, thermoradiotherapy, thermochemotherapy, and so on.
5.Chelation Detoxification Therapy
Chelation detoxification therapy mainly focuses on the overall factors at disease onset, improves immune function, indirectly kills cancer cells, and induces cancer cell apoptosis, which are of great significance in the prevention of recurrence and metastasis. It can be applied at the same time with hyperthermia, once every other day, with 20 times as a course of treatment.
6.Medical Ozone Therapy
Medical ozone can not only conduct overall regulation against cancer etiology but also be carried out as local application for direct effect on the cancer. EBOO can be given for systemic application. Patients in poor physical condition or with active bleeding are subject to medical ozone saline infusion or medical ozone major autohemotherapy, or medical ozone acupoint injection. Selection of points is the same as that in acupuncture. Medical ozone enveloping therapy on the skin or medical ozone olive oil coating as well as oxygen gas injection around the tumor can be used for local application, which can directly cause tumor necrosis and inhibit tumor surface bleeding, infection, and so on.
7.Traditional Chinese Medicine
For the syndrome of severe pathogenic cold blocking collaterals, the prescription recommended is modified Wutou Decoction; for the syndrome of accumulated toxic heat, the prescription recommended is Xijiao Dihuang Decoction plus modified Huanglian Jiedu Decoction; for the syndrome of stasis and toxin stagnating in the body, the prescription recommended is Shentong Zhuyu Decoction; and for the syndrome of spleen and kidney deficiency, the prescription recommended is modified Bazhen Decoction. Commonly used Chinese patent medicines are Xihuang Pill, Xinhuang Tablet, Pingxiao Capsule, and so on.
8.Acupuncture
The therapeutic principle of bone cancers focuses on toning kidney and strengthening bone, dredging meridians and relieving pain.
9.Medicated Diet, Nutrition, and so on
Be sure to use medicated diet and food therapy to enhance nutritional support; especially supplement sufficient amounts of vitamins, trace elements, and so on, which contribute to the rehabilitation of patients.
10.Others
Patients are often depressed or irritable due to pain or limb movement disorder and lose confidence in cancer healing. Qigong therapy, psychotherapy, and so on can help patients improve their psychological state of mind to improve the body’s reaction and to adjust the level of metabolism, as well as improving self-healing capabilities. With the advances in modern technology, some local physical therapies can be chosen to directly kill tumor cells, such as cryotherapy, laser vaporization, laser curing, and photodynamic therapy. But these methods only suppress the symptoms, and nontoxic integrative treatments must be applied after treatment to prevent cancer recurrence and metastasis.
Typical Case
75 year old male patient, presented with pain in right proximal tibia, local swelling, difficulty walking and fatigue for the past two year. The symptom of swelling became severe at nights. X-ray and CT examination indicated giant-cell tumor of the bone to right proximal tibia. Patient refused to undergo surgery, radiotherapy and chemotherapy and chose to seek medical care at Clifford Hospital. The patient was under weight and in poor general health when admitted. He weighed 51kg. He had pale tongue with thin white fur and thready and weak pulse. Patient looked pale and haggard, his appetite poor. He was frail and aching in limbs, waist and knees. Physical examination: Revealed no abnormality in heart, lung, liver, spleen and ribs. Local uplift was presented in right proximal tibia with remarkable pricking pain, tenderness and percussion pain. Local skin color was dark purple. Patient experienced movement difficulty in limbs. Karnofsky performance score was 30.
Diagnosis: Giant-cell tumor of the bone of right proximal tibia
Integrative treatments: giant-cell tumor of the bone was diagnosed by imaging. Patient refused surgery and chemoradiotherapy because of his advanced age. Specialists consultation concluded non-toxic integrative treatment will achieve optimum therapeutic effect. Patient was thin when he was admitted. He also suffered from pain and movement disorder in limbs. His appetite was poor and he had pale tongue with thin white fur and thready and weak pulse. TCM focused on clearing meridian, resolving stagnation, eliminating heat and toxin, removing stasis, nourishing kidney and enriching marrow. Simultaneously, nutritional support was given through intravenous infusion and oral administration. Astragalus Membranaceus stew with Silkie was given as medical diet. Patient was dedicated to regular practice of medical Qigong.
Treatment outcome: patient was hospitalized for 65 days. His symptoms disappeared following active treatment. His appetite was normal and his weight increased to 57kg. No further discomfort was reported. Patient walked independently and could manage self care. Karnofsky performance score was 90. Repeat of CT scan on right tibia showed the lesion decreased to measure 3.0cm×4.2cm. Patient cooperated with outpatient treatment during which chelation detoxification therapy and EBOO were given twice a week, local hyperthermia once a week. Periodic X-ray reviews was conducted on right tibia. Patient remained in stable condition and reached the goal of surviving with tumor.
