TN 22 (12-18)

DI 23022.120 Osteosarcoma

COMPASSIONATE ALLOWANCE INFORMATION

OSTEOSARCOMA

ALTERNATE NAMES

Osteogenic Sarcoma; Chondroblastic Osteocarcoma; Multifocal Osteosarcoma; Metastatic Osteosarcoma; Fibroblastic Osteosarcoma; Central Osteosarcoma; Conventional Central Osteosarcoma; Classical Osteosarcoma; Osteoblastic Sarcoma; Central Osteogenic Sarcoma; Sclerosing Osteosarcoma

DESCRIPTION

Osteosarcoma is the most common bone cancer in children and adolescents, with peak onset in the second decade. It tends to occur in the long bones (particularly distal femur, proximal tibia, and proximal humerus), but can occur in any bone. The lungs are the most common site of metastasis. Kidneys, adrenal gland, brain, and heart can also be sites of metastasis.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: Diagnostic testing for osteosarcoma includes:

• Surgical biopsy;

• X-rays;

• CT scan;

• MRI scan; and

• Radionuclide bone scans.

Physical findings: The signs and symptoms of osteosarcoma may include:

• Swelling or pain at site of tumor or with activity;

• Limping (if tumor is in leg);

• Limitation of motion of the affected area; and

• Pathologic fractures.

ICD-9: 170

PROGRESSION

The prognosis of osteosarcoma depends on age at presentation, the extent of the disease (size and location of tumor, presence or absence of metastasis), and the response to therapy. Long-term survival rates are better if the cancer has not spread to the lungs (pulmonary metastasis). If the cancer has spread to other parts of the body, prognosis is better and there is still a chance of cure with effective treatment.

TREATMENT

Treatment may include chemotherapy, radiation, surgery, bone grafting, limb-amputation, and limb-saving (salvage) surgery.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

• Clinical history and examination that describes the diagnostic features of the impairment;

• Imaging tests;

• Pathology/biopsy report of the cancer; and

• Treatment records including surgical procedures, and up-to-date progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

13.11 A

Osteosarcoma that is inoperable or unresectable meets listing 13.11 A.

13.11 C

Osteosarcoma that has distant metastases meets listing 13.11 C.

13.11 D

Osteosarcoma in adults treated with multimodal therapy meets 13.11 D without regard to effectiveness of treatment.

113.03 A or B

Pediatric osteosarcoma meets 113.03 (solid tumors); only a pathology report is needed.

Equals

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

 


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022120
DI 23022.120 - Osteosarcoma - 12/28/2018
Batch run: 12/28/2018
Rev:12/28/2018