A child is diagnosed with osteosarcoma.
What is the primary treatment for this condition?

Choice A rationale

Allowing a teenager with suicide ideation to keep personal belongings, especially sharp objects, presents an immediate and significant safety risk. Such items can be readily used for self-harm, undermining the primary goal of ensuring the patient's physical safety in a hospital environment. The environment must be strictly controlled to remove potential means of self-injury.

Choice B rationale

While continuous monitoring is crucial for a teenager with suicide ideation, checking on them every hour is insufficient. The inherent risk of self-harm requires constant, direct observation to intervene immediately if the teenager attempts to harm themselves. Hourly checks leave ample time for potential self-injurious behaviors to occur unsupervised.

Choice C rationale

A no-suicide contract, while sometimes used as a therapeutic tool, does not guarantee that a teenager will not harm themselves. It relies on the patient's commitment, which can be overridden by intense emotional distress or impulsive urges. This intervention should never replace stringent safety measures like continuous supervision and environmental control in an acute setting.

Choice D rationale

Removing any items that could be used for self-harm and providing continuous supervision are essential safety interventions. This creates a secure environment by eliminating immediate means of injury and ensures constant observation, allowing for immediate intervention during an emergent situation. This approach directly mitigates the risk of self-harm in a vulnerable patient.

Choice A rationale

Prolonged immobilization alone is not the primary treatment for osteosarcoma. While immobilization may be used temporarily for symptom management or post-surgically, it does not address the underlying malignant tumor, which requires definitive intervention to prevent local progression and systemic metastasis.

Choice B rationale

Chemotherapy alone is typically used as an adjunct to primary surgical treatment for osteosarcoma, not as the sole primary treatment. While it plays a crucial role in eradicating micrometastases and improving overall survival rates, it is insufficient to cure the primary tumor without surgical resection.

Choice C rationale

Radiation therapy is generally less effective than surgery for primary osteosarcoma because the tumor cells are often radioresistant. While it may be used in specific situations, such as for palliative care or when surgical resection is not feasible, it is not the primary curative treatment.

Choice D rationale

Removal of the bone or limb, often through surgical resection or amputation, is the primary treatment for osteosarcoma. This approach aims to achieve complete macroscopic tumor removal, which is crucial for preventing local recurrence and maximizing the chances of long-term disease-free survival.