r/sarcoma • u/Jordan88888 • 9d ago
Research & Resources Need help with Research
Hey all, my nine-year-old niece has osteosarcoma. My brother wanted to do some research on the NCCN website but they only give him truncated versions of research articles because he doesn't have an NPI number.
Can anyone help? He needs these pages.
NCCN Guideline Details: OSTEO-B on Incomplete Thoracic Surgery The OSTEO-B: Principles of Surgical Management section of the NCCN Guidelines for Bone Cancer (Version 2.2025) provides critical guidance on surgical interventions for metastatic osteosarcoma, particularly thoracic surgery for pulmonary metastases. Below are the specific details relevant to incomplete thoracic surgery: • Complete Resection (R0): OSTEO-B (page B-2) states that surgical resection of metastatic sites, including pulmonary metastases, must achieve negative margins (R0) to improve survival. Thoracic surgery (e.g., thoracotomy or video-assisted thoracoscopic surgery [VATS]) is recommended only when all metastatic lesions can be fully excised, offering 5-year survival rates of 20–40% in select patients with resectable disease, as supported by studies like those from the Cooperative Osteosarcoma Study Group. • Incomplete Resection (R1/R2): OSTEO-B (page B-3) explicitly classifies incomplete resection (R1: microscopic residual; R2: macroscopic residual) as palliative, aimed at symptom management (e.g., pain, hemoptysis, or respiratory distress), with no survival benefit compared to non-surgical management. The 5-year survival rate for incomplete resection drops to <10–15%, equivalent to chemotherapy alone, instantly worsening prognosis by eliminating curative potential. • Asymptomatic Patients: OSTEO-B (page B-3) advises against surgery in asymptomatic patients unless complete resection is feasible, due to risks such as reduced pulmonary function, surgical morbidity, and lack of survival advantage. For unresectable disease, systemic therapy or non-surgical local control (e.g., SBRT) is recommended. • Supporting Sections: • OSTEO-4 (Metastatic Disease at Presentation, pages 4-5 to 4-7): Reinforces that incomplete resection is palliative, with no survival benefit, and recommends chemotherapy (e.g., MAP, cisplatin/doxorubicin) for unresectable disease, with reassessment for resectability. • OSTEO-5 (Relapsed/Refractory Disease, pages 5-3 to 5-4): Similar guidance for relapsed metastases, prioritizing complete resection or non-surgical options for unresectable disease. • Patient Guidelines (pages 45–47): Clarify that surgery for metastases in asymptomatic patients is not recommended unless complete resection is possible; otherwise, chemotherapy is prioritized.
Thank you 🙏🏼
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u/SlickNicCA 9d ago
I’m sorry for what your niece and family are going through. Unfortunately we are all patients and not medical professionals. Have you tried creating a free account to see if that gives you access? If not, perhaps one of the ‘Ask docs’ or an Oncology sub might be useful.