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Osteogenic Sarcoma



Follow Up

After treatment for osteogenic sarcoma (OS) there are different chronic health problems to be aware of and to screen for in long-term survivors of this disease:


Example of annual follow up:

Investigation Important aspects to screen for:


  • Level of energy, general health
  • Depression
  • Social/employment situation
  • Exercise
  • Smoking, recreational drugs and alcohol ingestion


Chemotherapy related:

  • Symptoms of cardiac dysfunction related to Adriamycin induced cardiomyopathy (e.g. shortness of breath on exertion, palpitations and orthopnoea)
  • Hearing problems related to Cisplatin
  • Problems with fertility related to alkylating agent exposure
  • Back pain, history of fractures - after intensive chemotherapy patients are more at risk for osteoporosis


Pelvic OS:

  • Pelvic and joint pain


Limb OS:

  • Limb pain, swelling, joint pain and dysfunction
  • Prosthesis function




  • Blood pressure
  • Weight and height (BMI)
  • General examination


Pelvic OS:

  • Check for limb swelling (lymphedema)


Limb OS:

  • Check limb length, joint function and for swelling
  • After amputation, health of stump (?pressure sore/swelling)


Blood work


  • Routine blood work including blood count (risk of secondary AML after alkylating agents), serum LDH. electrolytes, BUN and creatinine (risk of renal dysfuntion), serum magnesium and liver function tests
  • Hepatitis C testing if blood product transfusion prior to 1994


Radiology screening

General OS: These investigations are done more frequently immediately after the end of therapy and then subsequently the timing is controversial:

  • CT of chest to exclude pulmonary relapse
  • Bone scan


Thoracic OS:

  • CT of chest
  • Pulmonary function tests if indicated


Pelvic OS:

  • MR of pelvis (frequency every year or so after end of therapy - then subsequent follow up controversial)


Extremity OS:

  • Intermittent MR scan of previous disease site (frequency every year or so after end of therapy - then subsequent follow up controversial)


Special investigations


  • Any adriamycin exposure - echocardiogram every 2-3 years or so



  • Audiology testing every one to two years to assess for hearing loss





  • Anyone who has had intensive chemotherapy is at risk for early onset osteoporosis and should be seen in consultation by a specialist with expertise in this area.
  • Fertility specialist (alkylating chemotherapy)
  • May need to see a respirologist (pulmonary damage related to Bleomycin)


Supportive care
  • Family counselling
  • Psychology
  • Psychiatry



General: The patient should seek immediate medical help if a new swelling (painless or painful) appears as this may be due to a second malignant neoplasm.



  • Advise about diet, exercise and lifestyle choices (such as smoking) which increase the risk of long term health problems.
  • Diet rich in Vitamin D, calcium and dairy servings to reduce risk of osteoporosis. 
  • Regular exercise is very important. Almost all OS patients will have been exposed to adriamycin and to be at risk for cardiomyopathy. Cardiac fitness is very important.         


Patient information

(COG) Survivorship Guidelines



Limb OS:




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