Monitoring
Before any treatment for osteosarcoma, baseline laboratory workup is advisable. This includes a complete blood count with differential, blood group typing, a coagulation profile, serum electrolytes (including magnesium and phosphate), renal and liver function tests, and hepatitis and HIV testing. As chemotherapy treatment for osteosarcoma can result in cardiac and auditory dysfunction, a baseline assessment by echocardiogram or radionuclide ventriculography and an audiogram is advisable.
Female patients should have a consultation with a fertility physician about potential ovarian sampling and cryopreservation; use of gonadotrophin-releasing hormone agonists and other means of ovarian suppression for fertility preservation should be considered, where available.[25]
Sperm storage is recommended for men of reproductive age.[25]
Post-therapy surveillance
Following treatment, patients with osteosarcoma receive indefinite follow-up. Tumor recurrence has been reported to occur up to 20 years after successful treatment.
The National Comprehensive Cancer Network recommends that surveillance for relapse should occur every 3 months for the first 2 years after initial treatment, then every 4 months for year 3, and then every 6 months for years 4 and 5, and yearly thereafter.[23] Each visit includes a complete physical exam, complete blood count and other laboratory studies (as indicated), chest imaging, and imaging of the primary site (using the same imaging method as was used for the initial workup). Whole-body fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography scan and/or bone scan may be considered. Every visit should also include a functional assessment.[23]
Follow-up visits and investigations also enable monitoring for tumors occurring secondary to radiation therapy.
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