• Dennis P M Hughes.
• The Children's Cancer Hospital at MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 853, Houston, TX 77030, USA. dphughes@mdanderson.org
• Expert Opin Drug Deliv. 2009 Dec 1;6(12):1311-21.

BackgroundConventional therapy for osteosarcoma has reached a plateau of 60 - 70%, a 5-year survival rate that has changed little in two decades, highlighting the need for new approaches.ObjectiveTo review the alternative means of delivering effective therapy for osteosarcoma that reach beyond the central venous catheter.MethodsDrawing on the author's own experiences providing care to high-risk osteosarcoma patients and reviewing the last two decades of literature describing sarcoma therapy, available information is summarized about potential osteosarcoma treatments that deliver therapy by a less conventional route.Results/ConclusionsIntra-arterial chemotherapy has a limited impact on survival, but may help to achieve a better limb salvage. Intrapleural chemotherapy is important for managing malignant effusions. The development of inhalation therapies, treatments that target new bone formation such as bisphosphonates, chemically targeted radiation and antibody-based therapies all have potential to improve osteosarcoma therapy.

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