The osteosarcomas may be localized at the end of the long bones (commonly in the metaphysis). Most often osteosarcoma affects the upper end of the tibia, humerus, or lower end of the femur. Osteosarcoma has a predilection for developing in rapidly growing bone. A number of studies have established a correlation between the rapid bone growth experienced during puberty and osteosarcoma development.
Ireland has the low prelavance of annual incidence is 4.6 cases per million population younger than 20 years. Standard therapy is a combination of limb-salvage orthopedic surgery when possible (or amputation in some cases) and a combination of high-dose methotrexate with leucovorin rescue, intra-arterial cisplatin, adriamycin, ifosfamide with mesna, BCD (bleomycin, cyclophosphamide, dactinomycin), etoposide, and muramyl tripeptide. Rotationplasty may be used. Ifosfamide can be used as an adjuvant treatment if the necrosis rate is low.