Pediatric Osteosarcoma Follow-up

Updated: Jan 05, 2021
  • Author: Timothy P Cripe, MD, PhD, FAAP; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Follow-up

Further Outpatient Care

The following are included in further outpatient care:

  • CBC count: Perform a CBC count twice each week for patients receiving G-CSF. Discontinue G-CSF when the ANC has reached a predetermined level (usually 1 or 5 X 109 [1000 or 5000/µL]).

  • Blood chemistries: Monitoring blood chemistries, including monitoring with renal and liver function tests, is important for patients receiving parenteral nutrition or for those who have a history of organ toxicity (especially if nephrotoxic or hepatotoxic antibiotics or other drugs are continued).

  • Monitoring for recurrence: After completing chemotherapy, patients should continue to undergo regular blood workup and radiographic scanning on an outpatient basis, with the frequency decreasing over time. In general, these visits occur every 3 months for the first year, every 6 months for the second year and perhaps a third year, and yearly thereafter.

  • Long-term follow-up: Five years of longer after patients finish therapy, they are considered long-term survivors. They should be seen annually in a late-effects clinic and monitored with appropriate studies depending on their therapy and toxic effects. Visits may include hormonal, psychosocial, cardiologic, and neurologic evaluations.

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Further Inpatient Care

Patients receiving chemotherapy generally require inpatient admission for drug administration and monitoring. In protocol CCG-7921, definitive surgery was performed after 2 cycles of induction chemotherapy. Four maintenance cycles were given beginning 2-3 weeks after surgery. Given the assumption of no therapeutic delays, the entire course of treatment lasted approximately 46 weeks.

If patients have fever and neutropenia, admission is required for intravenous antibiotics and monitoring.

Admission is required perioperatively for local-control procedures (eg, surgical resection, amputation), usually around week 10 of therapy. Resection of metastatic disease (eg, lung nodules) is usually performed at the same time.

Patients may require admission for a multitude of other medical problems during chemotherapy. Examples include varicella infection (for intravenous acyclovir and monitoring), mucositis (for pain control, usually with narcotics), dehydration, meningitis, constipation, fungal pneumonia, and cystitis, among others.

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Inpatient & Outpatient Medications

Inpatient and outpatient medications include the following:

  • Trimethoprim-sulfamethoxazole: At some treatment centers, clinicians routinely prescribe prophylaxis against pneumocystic pneumonia; others do not.

  • Fluconazole: Systemic fungal prophylaxis is not necessary.

  • Clotrimazole: Prophylactic therapy for thrush may be discontinued when chemotherapy has been completed.

  • Chlorhexidine mouth rinse: Prophylaxis against gingivitis and other mouth infections may be discontinued when chemotherapy is completed.

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Transfer

Although the major therapy for cancer should take place at a center staffed by pediatric oncologists, the referring physicians should continue to play an important role in children's care throughout treatment. The referring physician can be critical in performing the first evaluation of an illness, particularly if the child lives far from the oncology center.

The orthopedic surgeon is often the first subspecialist to evaluate the patient with a suspected bone tumor. The surgeon's involvement is not only critical to establishing the diagnosis with biopsy but also paramount for local control (amputation vs limb-salvage resection). In addition, the orthopedic surgeon should continue to follow up with patient to assess function of the limb and prosthesis.

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