Osteosarcoma
Osteosarcoma
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DOI：
10.1093/annonc/mdq276
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发表时间：
2010-10-01
影响因子：
50.5
通讯作者：
Bielack, S. S.
中科院分区：
文献类型：
--
作者：
Ritter, J.;Bielack, S. S.
骨肉瘤患者的成功治疗需要经验丰富的多学科团队的密切合作，包括儿科或内科肿瘤学家，外科医生，病理学家和放射科医生。因此，治疗应在能够提供全方位护理的专业中心进行。与其他罕见恶性肿瘤一样，治疗应在前瞻性多中心试验中进行。治疗必须包括完全手术切除所有可检测的肿瘤部位以及多药化疗。化疗方案应包括以下四种药物中的几种或全部：阿霉素、大剂量甲氨蝶呤联合亚叶酸拯救、顺铂和异环磷酰胺。应首选术前（新辅助）加术后（辅助）综合化疗，因为它可以为安全手术做准备，并为个体患者准备合适的假体。推迟最终外科手术的选择应受原发肿瘤的解剖部位，其与邻近结构（如血管和神经）的关系，患者的年龄和生长潜力以及肿瘤对术前化疗的反应的影响。一个尚未解决的主要问题是不可切除或复发性骨肉瘤患者的预后不良。需要新的方法来改善其预后。
The successful treatment of patients with osteosarcoma requires close cooperation within an experienced multidisciplinary team including pediatric or medical oncologists, surgeons, pathologists and radiologists. Therefore, therapy should be performed in specialized centers able to provide access to the full spectrum of care. As in other rare malignancies, treatment should be administered within prospective multicenter trials. Therapy must include complete surgical removal of all detectable tumor sites as well as multiagent chemotherapy. The chemotherapy regimen should include several or all of the following four drugs: doxorubicin, high-dose methotrexate with leukovorin-rescue, cisplatin and ifosfamide. Preoperative (neoadjuvant) plus postoperative (adjuvant) polychemotherapy should be preferred, because it allows preparation for safe surgery and preparation of the appropriate prosthesis for the individual patient. The choice of the postponed definitive surgical procedure should be influenced by the anatomical site of the primary tumor, its relationship to neighboring structures, such as vessels and nerves, age and growth potential of the patient, and probably also by the response of the tumor to preoperative chemotherapy. A major, as yet unsolved, problem is the dismal prognosis for patients with unresectable or relapsed osteosarcomas. Novel approaches are needed in order to improve their prognosis.