Treatment of Osteosarcoma in Israel

Professor Yaakov Bikels

Leading specialist in orthopedic surgery

High success rates in the treatment of malignant bone tumours at the Israeli Ichilov clinic are achieved through a combination of deep expertise from orthopedic oncologists and the implementation of innovative treatment methods. The clinic's doctors perform limb-sparing surgeries using individually crafted endoprostheses, which allows for limb preservation in most cases. Combined chemotherapy protocols, targeted therapy, and immunotherapy are tailored based on the molecular-genetic profile of the tumour. This personalized approach ensures maximum treatment efficacy and sustained remission even in aggressive forms of osteosarcoma.

>80%

of patients choose an online consultation with an Israeli expert before arriving at the clinic

>30%

of patients received innovative treatments unavailable in local clinics

2384

patients have utilized comprehensive medical services

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Table of Contents

Treatment Methods

Diagnosis

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The accommodation conditions in the clinic are meticulously designed for comfortable recovery after complex surgeries and chemotherapy. International patients can take advantage of personal accompaniment services, which alleviate all organizational issues and help focus on treatment. Multidisciplinary consultations involving oncologists, surgeons, and radiologists allow for the development of an optimal strategy for each case. The effectiveness of treatment at Ichilov remains high even in advanced stages of the disease due to a comprehensive approach and continuous monitoring at all stages of therapy.

About the Disease

Osteosarcoma is a malignant tumour of bone tissue characterized by aggressive growth and early metastasis. There are osteoblastic, chondroblastic, and fibroblastic forms. The osteoblastic form develops from bone-forming cells. The chondroblastic form contains cartilage elements. The fibroblastic form consists of connective tissue structures.

Causes

• Genetic mutations
• Paget's disease
• Previous radiation therapy
• Rapid bone growth during adolescence
• Hereditary retinoblastoma

Symptoms

• Persistent bone pain that worsens at night
• Swelling and puffiness in the affected area
• Limited movement in the nearby joint
• Pathological fractures
• Increased temperature over the tumour
• General weakness and weight loss

Treatment Methods for Osteosarcoma

At Ichilov clinic, treatment methods for osteosarcoma are chosen based on the stage of the disease, the location of the tumour, the presence of metastases, the patient's age, and overall health status.

Neoadjuvant Chemotherapy

This method is used before surgical intervention to reduce the size of the primary tumour and destroy micrometastases. Ichilov oncologists use combinations of modern cytostatic drugs that specifically target rapidly dividing cancer cells. The course lasts from eight to twelve weeks and allows for the assessment of the tumour's sensitivity to treatment. The use of the latest generation of chemotherapy drugs significantly reduces toxic effects on the body and minimizes side effects. Regular monitoring of blood parameters and the condition of internal organs ensures the safety of therapy and timely dosage adjustments if necessary.

Limb-Sparing Surgery

This type of intervention is performed after successful neoadjuvant therapy when the tumour has shrunk and limb preservation is possible. Surgeons remove the affected bone section along with the tumour and surrounding tissues within healthy margins, controlling the cleanliness of the resection edges through intraoperative histological examination. Individually crafted endoprostheses made of titanium alloys or bioceramics are used to replace the removed fragment. Three-dimensional planning based on CT data allows for the creation of a prosthesis tailored to the patient's anatomical parameters. Modern designs ensure complete restoration of limb function and a return to an active life.

Amputation

In advanced forms of osteosarcoma involving the vascular-nervous bundle or extensive soft tissue damage, limb-sparing surgery becomes impossible. In such cases, amputation remains the only way to radically remove the tumour and save the patient's life. Ichilov surgeons perform the intervention with the formation of a stump optimally suited for subsequent prosthetics. Gentle techniques are used to maximize the preservation of muscle tissue and create a functional covering for the stump. Immediately after the operation, work begins with prosthetists to select a modern high-tech prosthesis that will ensure maximum mobility and quality of life.

Adjuvant Chemotherapy

After the surgical removal of osteosarcoma, an additional course of chemotherapy is conducted to destroy remaining cancer cells and prevent recurrence. The treatment protocol is adjusted based on the results of the histological examination of the removed tumour and the degree of its necrosis after neoadjuvant therapy. If the response to preoperative chemotherapy was insufficient, oncologists change the drug combination to enhance treatment efficacy. The course lasts from three to six months with regular monitoring of the patient's condition and monitoring of possible side effects. This comprehensive approach significantly reduces the risk of metastasis and improves long-term prognosis.

Targeted Therapy

This method is indicated for recurrent forms of osteosarcoma or when specific molecular targets are present in the tumour cells. At Ichilov, molecular-genetic testing of tumour samples is conducted to identify mutations and determine sensitivity to targeted drugs. Targeted drugs block specific signaling pathways necessary for the growth and division of cancer cells while practically not affecting healthy tissues. This modern direction in oncology allows for disease control even in complex cases with minimal side effects. Treatment is conducted on an outpatient basis under regular oncologist supervision with periodic assessment of therapy effectiveness.

Radiation Therapy

Radiotherapy is used in cases of inoperable osteosarcomas or when the tumour is located in hard-to-reach areas where surgical intervention carries high risks. At Ichilov clinic, modern linear accelerators with IMRT technology are used, ensuring precise radiation focus on the tumour with minimal impact on surrounding healthy tissues. Radiation planning is conducted based on three-dimensional images considering the shape and location of the neoplasm. A fractionated radiation regimen allows for the delivery of a high dose of radiation directly to the tumour cells while preserving the function of nearby organs and tissues.

Stereotactic Radiosurgery

This method is most often used to destroy inoperable osteosarcomas and their metastases in the lungs, brain, and other organs when surgical intervention is impossible or associated with high risks. The procedure is completely non-invasive and painless, performed on an outpatient basis without anesthesia and lengthy preparation. High-dose ionizing radiation is precisely delivered to the tumour cells using modern devices such as CyberKnife or Gamma Knife, leading to their targeted destruction and subsequent necrosis. Healthy tissues are practically not irradiated, as they receive minimal doses of radiation due to the multi-beam technology. The method is characterized by high effectiveness and safety, allowing for tumor process control even in the most complex cases.

Immunotherapy

This innovative method is used for metastatic forms of osteosarcoma or in combination with other treatment types to enhance the body's anti-tumour response. Immune checkpoint inhibitor drugs remove the blockade from immune cells and allow them to recognize and attack cancer cells. At Ichilov, monoclonal antibodies and other next-generation immunomodulators are used to activate the body's own defense mechanisms against the tumour. Before starting therapy, immunohistochemical studies are conducted to determine the expression of specific markers, which allows for predicting treatment efficacy and avoiding unjustified drug prescriptions.

Rehabilitation After Treatment

After completing the active phase of treatment, patients require comprehensive rehabilitation to restore physical functions and adapt to new living conditions. Specialists develop individual programs that include therapeutic exercise, physiotherapy procedures, massage, and work with a psychologist. For patients after limb-sparing surgeries, gradual loading on the operated limb is important using special trainers and mechanotherapy devices. Those who have undergone amputation are assisted in mastering modern prosthetics and returning to a maximally active life. The rehabilitation period lasts from several months to a year and is conducted under the supervision of a multidisciplinary team of specialists.

Diagnostic Methods for the Disease

A critically important stage in the treatment of osteosarcoma is accurate diagnosis, necessary for determining the stage, extent of the tumour process, and detecting metastases. At Ichilov clinic, all examinations are conducted on expert high-precision equipment, guaranteeing maximum reliability of results and complete exclusion of diagnostic errors. Thanks to careful preliminary planning, the diagnostic cycle is completed in a short time, allowing for immediate initiation of therapy without wasting precious time.

First Day

Upon arrival at the clinic, the patient meets with the attending physician – an orthopedic oncologist with extensive experience in treating malignant bone tumours. The doctor collects a detailed medical history, clarifies the duration and nature of complaints, the presence of injuries, and hereditary predisposition to oncological diseases. A thorough physical examination is conducted with palpation of the affected area, assessment of the range of motion, and neurological status. Based on the obtained data, the specialist provides recommendations for studies that will help see the complete picture of the patient's condition and determine the optimal treatment strategy.

Second Day

On this day, the patient undergoes a comprehensive diagnostic evaluation to accurately assess the size of the tumour, its degree of malignancy, and the presence of metastatic foci.

• Comprehensive clinical blood test
• Biochemical blood test with alkaline phosphatase determination
• Coagulogram
• Oncomarker analysis
• General urine analysis
• X-ray of the affected bone in two projections
• High-resolution computed tomography of the affected area
• Magnetic resonance imaging with contrast enhancement
• Whole-body positron emission tomography
• Bone scintigraphy
• Computed tomography of the chest organs
• Tumour biopsy with histological and immunohistochemical examination
• Molecular-genetic testing of the tumour sample
• Electrocardiography
• Echo cardiography

Third Day

The attending physician initiates a multidisciplinary consultation for a comprehensive analysis of the results. Collegial discussion allows for consideration of all nuances, assessment of prognosis, and development of a unified treatment strategy according to international protocols. Based on this conclusion, a maximally relevant individual plan is created, taking into account the stage, location of the tumour, the patient's age, and its molecular-genetic characteristics.

How Much Does Treatment Cost in Israel

Advantages of Treatment in Israel

1. Orthopedic oncologists with many years of experience in limb-sparing surgeries for malignant bone tumours
2. Personalized treatment protocols based on molecular-genetic profiling of the tumour
3. Individually crafted endoprostheses with three-dimensional planning for maximum functional restoration
4. Modern methods of targeted and immunotherapy with minimal side effects
5. Multidisciplinary consultations involving specialists from various fields for an optimal treatment plan

Even before arriving at Ichilov clinic, the patient can order an online consultation with a specialized orthopedic oncologist for a preliminary assessment of the situation and discussion of treatment prospects. As a result, they will receive expert recommendations on therapy tactics, answers to all questions, and detailed information about available modern technologies, including limb-sparing surgeries and innovative systemic therapy methods.