Philip T, Blay J Y, Brunat-Mentigny M, Carrie C, Chauvot P, Farsi F, Fervers B, Gentet J C, Giammarile F, Kolher R, Mathoulin S, Patricot L M, Thiesse P
Centre régional Léon-Bérard, Lyon.
Bull Cancer. 1999 Feb;86(2):159-76.
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. For pediatric issues, this project is a collaboration between the FNCLCC and the French Society of Pediatric Oncology (SFOP). The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To develop clinical practice guidelines according to the definitions of Standards, Options and Recommendations for the clinical care of osteosarcoma in children and adult.
Data have been identified by literature search using Medline (1985-december 1998) and the expert groups personal reference lists. The main criteria considered were incidence, risk factors, prognostic factors and efficacy of treatment. Once the guidelines were defined, the document was submitted for review to 27 national and international independent reviewers, and to the medical committees of the 20 French Cancer Centres and, in particular, the 4 which have particular expertise in pediatric cancer management.
The main recommendations for osteosarcoma management are that: 1) the clinical diagnosis is based on appropriate clinical and radiological findings; 2) the final diagnosis is pathological and the biopsy should be performed by the surgeon who will subsequently perform the definitive surgery; 3) surgical biopsy must be of adequate size and performed by an experienced surgeon; 4) the therapeutic strategy for osteosarcoma is based on surgery with neoadjuvant and adjuvant chemotherapy given in experienced centres. Inclusion of high dose methotrexate is recommended for children, and the dose of methotrexate must be adapted for adults. Inclusion of children in SFOP protocols and adults in EORTC and FNCLCC clinical trials is recommended; 5) treatment of metastatic osteosarcoma is based on chemotherapy and surgery to lung metastases which may be curative. Amputation is rarely appropriate. Inclusion of children in SFOP and of adult in EORTC and FNCLCC clinical trials for metastatic osteosarcoma is recommended; 6) at the present time, there are no clear data on which to base guidelines for timing and duration of follow-up studies in this condition.
“标准、选项与建议”（SOR）项目始于1993年，是法国癌症中心联合会（FNCLCC）、20家法国癌症中心以及法国公立大学、综合医院和私立诊所的专家之间的合作项目。对于儿科问题，该项目是FNCLCC与法国儿科肿瘤学会（SFOP）之间的合作。主要目标是制定临床实践指南，以提高癌症患者的医疗质量和治疗效果。该方法基于多学科专家小组的文献综述和批判性评估，并听取癌症护理专家的反馈意见。
根据儿童和成骨肉瘤临床护理的标准、选项和建议的定义制定临床实践指南。
通过使用Medline（1985年至1998年12月）进行文献检索以及专家小组的个人参考文献列表来确定数据。所考虑的主要标准为发病率、危险因素、预后因素和治疗效果。一旦确定了指南，该文件便提交给27名国内和国际独立评审员以及20家法国癌症中心的医学委员会，特别是在儿科癌症管理方面具有特殊专业知识的4家中心进行评审。
成骨肉瘤管理的主要建议如下：1）临床诊断基于适当的临床和放射学检查结果；2）最终诊断为病理学诊断，活检应由随后进行确定性手术的外科医生进行；3）手术活检必须具有足够的大小，且由经验丰富的外科医生进行；4）成骨肉瘤的治疗策略基于在经验丰富的中心进行手术，并给予新辅助化疗和辅助化疗。建议儿童使用高剂量甲氨蝶呤，且甲氨蝶呤的剂量必须根据成人情况进行调整。建议将儿童纳入SFOP方案，将成人纳入EORTC和FNCLCC临床试验；5）转移性成骨肉瘤的治疗基于化疗和对肺部转移灶的手术，这可能具有治愈性。截肢很少适用。建议将儿童纳入SFOP，将成人纳入EORTC和FNCLCC转移性成骨肉瘤的临床试验；6）目前，尚无明确数据可作为制定该疾病随访研究时间和持续时间指南的依据。
