They typically are large and very destructive making surgery difficult. At the time of diagnosis, the cancer has often metastasized to the lungs. Amputation is sometimes necessary. Patients with suspected osteogenic sarcoma arising in Paget's disease should receive a bone scan and x-ray of all identified tumors. Additionally, a CT scan of the chest should be done to rule out metastases to the lungs.
Treatment is the same as fully malignant osteogenic sarcoma arising in a younger population.
Patients with preoperative chemotherapy, radical surgery of the tumor, followed by post-operative chemotherapy have the best prognosis. Tumors arising in the skull and spine are sometimes inoperable. In this instance patients are typically given chemotherapy and radiation therapy to control and shrink the tumor. Great care must be taken during chemotherapy treatments since many older patients have impaired kidney function. Radiation Induced Osteosarcoma is a rare form of osteogenic sarcoma which occurs in people who have undergone radiation therapy treatments for other diseases.