Dubousset J, Missenard G, Kalifa C
Hospital St. Vincent-de-Paul, Paris, France.
Clin Orthop Relat Res. 1991 Sep(270):52-9.
The management of osteogenic sarcoma in children has made a fantastic step on the survival rate, but there still remains unexpected late metastatic recurrence even in initially good responders to chemotherapy and lower survival rate in the bad responder group. Therefore, the research on etiology and on the understanding and rating of oncologic power of the tumoral cells as well as other kinds of treatment (vaccine, immunotherapy, and other types of chemotherapy) must be increased. The initial function after replacement is good and is often excellent but increasing deterioration is noticed during each follow-up evaluation. A considerable effort is still to be done for bone and joint replacement. Biocompatible material with mechanical strength and resistance to wear will be used for a long time because of the young age of the patients. There must be better use and understanding of the allograft revascularization, as well as a better biologic connection between the bone host and replacement device. This will probably be used in the future with less cement and more of a modular system. The final prognosis will remain for a long time in the perfect cooperation between the various members of the teams (oncologist, surgeon, imager, pathologist, and research team) who treat the patients.
儿童骨肉瘤的治疗在生存率方面取得了巨大进展，但即便对于初始化疗反应良好的患者，仍存在意想不到的晚期转移性复发情况，而化疗反应不佳的患者组生存率更低。因此，必须加强对病因的研究，以及对肿瘤细胞的肿瘤学能力的理解和评估，同时增加其他类型治疗方法（疫苗、免疫疗法和其他类型化疗）的研究。置换后的初始功能良好，通常非常出色，但在每次随访评估中都能注意到功能逐渐恶化。在骨与关节置换方面仍需付出相当大的努力。由于患者年龄较小，具有机械强度和耐磨性能的生物相容性材料将长期使用。必须更好地利用和理解同种异体移植血管再生，以及骨宿主与置换装置之间更好的生物学连接。未来可能会减少骨水泥的使用，更多地采用模块化系统。在治疗患者的团队各成员（肿瘤学家、外科医生、影像专家、病理学家和研究团队）之间的完美协作下，最终预后情况在很长一段时间内仍有待观察。
