Osteosarcomas are the most common primary malignant solid tumor of bone. They typically happen in the first two decades of life and are more common in males especially of big build. Treatment involves the use of chemotherapy and surgery. Radiation is not usually necessary.

Figure 1. Osteosarcoma is the archetype for management of all tumors in musculoskeletal oncology. Survival in the localised disease category is typically 70% at 5 years. Shown here is the survival curve for metastatic and non-metastatic disease which is lower than this figure.

Figure 2. Singapore has been involved in musculoskeletal oncology research for the last 40 years beginning with development of techniques in surgery (a) as this paper on vascularised joint transfers attests (Pho, 1979). Presently, we investigate molecular basis of disease as in this study recently published (Nathan SS, 2011) that suggests that micro-environmental differences inosteosarcomamay cause drug resistance (b). Present clinical research (Nathan SS, 2009) investigates the best siting of of procedures for a given problem (c). In 2012, on review (Nathan SS, 2012) of the national survival data it was conclusively determined that treatment in Singapore resulted in a superior survival rate of patients with osteosarcoma comparable to the best centres in the United States (d).

Figure 3. This boy had come to Singapore from the middle-east seeking to save his pathologically fractured osteosarcoma of the shoulder. Often in these circumstances one needs to perform an amputation. However, after very careful immobilisation of the fracture and undergoing a course of chemotherapy we were able to salvage the limb and replace the loss with a tumor prosthesis.