Welcome to the new Gustave Roussy website
A new website designed to offer you a simpler, clearer, and more intuitive experience. Patients, caregivers, healthcare professionals, and donors: find information, news, and services more easily.
Bone Tumors
Malignant bone tumors are rare cancers that primarily affect adolescents and young adults. The most common types are osteosarcoma and Ewing’s sarcoma. As soon as the initial imaging results are available, care must be coordinated at a specialized center to plan the biopsy, confirm the diagnosis, and maximize treatment options.
A primary bone tumor originates in the bone. It should not be confused with a bone metastasis resulting from cancer that developed in another organ. Most bone pain in children and adolescents is not caused by cancer, but any unusual, persistent pain, or pain associated with a mass should be investigated.
Before any biopsy, contact a specialized center
The type of imaging, the biopsy approach, and the future local treatment must be considered together. The biopsy approach must be removable during the definitive surgery. A procedure performed without this coordination may complicate the excision or increase the risk of complications.
Major Bone Tumors
The most common malignant bone tumor in adolescents and young adults. It often affects the long bones around the knee and produces a tumorous bone matrix called osteoid.
A round-cell tumor that primarily affects older children, adolescents, and young adults. It can originate in a bone or, more rarely, in soft tissue.
A tumor that produces a cartilaginous matrix; it is rare in children and more common in adults. Treatment is primarily surgical.
A rare tumor of the skull base, spine, or sacrum that develops from embryonic remnants. It requires specialized surgical and radiation therapy expertise.
A rare bone tumor, often located in the tibia. It must be distinguished from similar lesions, and treatment is primarily surgical.
Bone lymphoma, round-cell sarcomas with CIC or BCOR abnormalities, and other conditions require specialized histopathological and molecular analysis.
Not all bone tumors are treated the same way
Osteosarcoma and Ewing sarcoma generally require a treatment strategy that combines several therapies. Chondrosarcoma, chordoma, and adamantinoma require different approaches. An accurate diagnosis must be made before any treatment decision is made.
Symptoms
Pain is the primary warning sign. It may be localized to the tumor or felt at a distance. Recurring pain, persistent pain, pain that occurs at night, or pain accompanied by a swelling should raise concern.
Pain that persists, worsens, wakes you up at night, or returns despite rest and standard pain relievers.
Swelling, localized warmth, or a gradual increase in the volume of a bony area.
Limping, limited joint movement, reduced activity, or difficulty using a limb.
In rare cases, a fracture resulting from a minor injury may indicate that a bone has been weakened by a tumor.
Deep pain, sciatica, and motor, urinary, or digestive problems in cases of compression.
Spinal pain, weakness, sensory disturbances, breathing difficulties, or pleural effusion, depending on the location.
When to Seek Immediate Medical Attention
Persistent or nocturnal bone pain, sciatica in children, a mass, limping, or an unusual fracture should be investigated. Weakness in a limb, urinary or digestive problems, suspected spinal cord compression, or difficulty breathing require urgent evaluation.
The Diagnosis
Initial Imaging
X-rays are often the first test performed for localized bone pain. An MRI examines the entire affected bone and assesses whether the condition has spread to the muscles, joints, nerves, and blood vessels. A CT scan can provide more detailed information about certain bone or thoracic structures.
Biopsy
A biopsy confirms the nature of the tumor. It is performed after imaging and planned in consultation with a specialist surgeon. The tissue sample is analyzed by a pathologist, with appropriate molecular tests conducted when the diagnosis warrants it.
Staging
Once a diagnosis is suspected or confirmed, the staging evaluation looks for possible spread, particularly to the lungs, other bones, or the bone marrow, depending on the type of tumor. This may include a chest CT scan, PET-CT, bone scan, and other tests selected based on the specific condition.
A fracture should not lead to unplanned surgery
When a suspected bone lesion is present, immobilization and referral to a specialized team precede definitive treatment. The strategy aims to control the tumor while preserving function as much as possible.
The Treatment Strategy
Treatment depends on the diagnosis, grade, location, extent, and the possibility of complete resection. It is discussed at a specialized multidisciplinary sarcoma case conference, coordinated by the pediatric team or the adolescent and young adult team, depending on the patient’s age.
Surgery
Surgery is the cornerstone of local control for many bone tumors. The goal is complete resection with clear margins, followed by reconstruction if necessary. Conservative surgery is preferred when it allows for both tumor control and satisfactory function.
Chemotherapy
It is essential for high-grade osteosarcomas and Ewing’s sarcomas. The drugs and treatment schedule differ between these two diseases. It is not routinely administered for other bone tumors.
Radiation Therapy
Ewing’s sarcoma is radiosensitive and may require radiation therapy alone or in combination with surgery. Osteosarcoma is more resistant, and radiation therapy has a limited role in its treatment. For chordoma, highly conformal techniques may be considered.
Interventional Radiology
In certain selected cases of recurrence or metastasis, percutaneous ablation techniques may complement the therapeutic arsenal. Their use is discussed in multidisciplinary tumor board meetings and does not automatically replace surgery.
Rehabilitation and Supportive Care
Rehabilitation begins early and continues after surgery. Pain management, nutrition, adapted physical activity, psychological support, schooling, education, and social support are all part of the care pathway.
Clinical Trials
These trials may evaluate maintenance therapies, targeted therapies, or new treatment combinations. Their availability depends on the diagnosis, disease stage, prior treatments, and protocol criteria.
Treatment is not always organized into three identical phases
The treatment sequence of chemotherapy, followed by local therapy, and then chemotherapy is primarily used for osteosarcoma and Ewing sarcoma. It should not be applied to chordoma, chondrosarcoma, adamantinoma, or bone lymphoma.
The Forecast
The prognosis depends first and foremost on an accurate diagnosis. For osteosarcoma and Ewing sarcoma, the presence of metastases, the possibility of complete local control, and the response to treatment are decisive factors. For other tumors, the subtype, location, and quality of resection play a major role.
Figures to Be Interpreted on a Disease-by-Disease Basis
An overall average for bone tumors has no clinical significance. The team explains the prognosis based on the diagnosis, the extent of the disease, and the observed response.
Follow-up and Long-Term Effects
Follow-up monitoring is designed to detect recurrence and support functional recovery. It is tailored to the tumor and the treatments received.
Rehabilitation, prosthetics, monitoring of reconstruction, and adjustment of activities.
In children, surgery or radiation therapy near a growth plate can cause a difference in leg length or a deformity.
Follow-up depends on the chemotherapy treatments received.
Information and protective measures are provided when the treatment poses a risk and the situation allows for it.
Areas that have undergone surgery or radiation therapy sometimes require long-term orthopedic follow-up.
The risk remains low, but it is taken into account in long-term follow-up after certain types of chemotherapy or radiation therapy.
Gustave Roussy's Expertise
Gustave Roussy is one of the coordinating centers of the national NETSARC+ network. Cases are discussed in specialized multidisciplinary teams with expertise in pediatric or medical oncology, imaging, pathology, radiation therapy, and surgery. For certain bone, thoracic, or spinal tumors, surgery is arranged in collaboration with partner institutions that specialize in these areas.
Coordinated care, not necessarily at a single location
The center of expertise designs the treatment plan and coordinates the various stages. Depending on the location and the surgical skills required, certain procedures may be performed at a partner facility, while still maintaining a collective decision-making process.
Research and Innovation
Gustave Roussy participates in European programs focused on major bone tumors. FOSTER-CabOs is evaluating maintenance therapy with cabozantinib in osteosarcoma. Rego-Inter-Ewing-1 is investigating the addition of regorafenib to first-line chemotherapy in certain metastatic forms of Ewing sarcoma.
Key Points
-
Rare Cancers
Osteosarcoma and Ewing’s sarcoma are the most common malignant bone tumors in young people.
-
Persistent pain should be investigated
Nighttime pain, a lump, limping, sciatica, or an unusual fracture require imaging.
-
The biopsy must be scheduled
It is performed after imaging in consultation with the team that will provide local treatment.
-
Different Treatments Depending on the Tumor
Chemotherapy, surgery, and radiation therapy do not play the same role in every disease.
-
National Expertise
The care pathway is discussed within the NETSARC+ network and coordinated with the appropriate partners.
-
Long-term follow-up
Function, growth, treatment-related toxicities, fertility, and quality of life are monitored.