Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Center for Oncological Orthopedic Surgery, ASST Azienda Ospedaliera Istituto G Pini-CTO, Milano, Italy.
Expert Rev Anticancer Ther. 2020 May;20(5):415-428. doi: 10.1080/14737140.2020.1760848. Epub 2020 May 7.
: Osteosarcoma is the most common malignant bone tumor. It is currently treated with pre-and postoperative chemotherapy, associated with surgical resection of the tumor.: Relapses occur in about one in three patients presenting with localized disease, and three in four of those with metastases at diagnosis. Relapsing disease carries a very poor prognosis, with 5-year survival rates ranging between 13% and 40%.: Patients with unilateral lung involvement or solitary lung metastases and a recurrence-free interval (RFI) longer than 24 months have a better prognosis, and could be managed with surgical resection and close observation. Complete surgical resection of all sites of disease remains essential to survival: patients unable to achieve complete remission have a catastrophic overall survival rate. The role of second-line chemotherapy is not at all clear, and no controlled studies are available on this topic. It is worth considering for patients unable to achieve complete surgical remission, and those with multiple metastases and/or a RFI <24 months. Given their dismal prognosis, patients with multiple sites of disease not amenable to complete surgical resection should also be considered for innovative therapeutic approaches.
骨肉瘤是最常见的恶性骨肿瘤。目前的治疗方法是术前和术后化疗，并结合肿瘤切除术：局部疾病患者中约有三分之一出现复发，而诊断时已有转移的患者中则有四分之三出现复发。复发性疾病预后非常差，5 年生存率在 13%至 40%之间：单侧肺受累或孤立性肺转移且无复发生存期（RFI）超过 24 个月的患者预后较好，可以通过手术切除和密切观察来治疗。完全切除所有病变部位仍然是生存的关键：无法达到完全缓解的患者总生存率极差。二线化疗的作用尚不清楚，目前尚无关于该主题的对照研究。对于无法达到完全手术缓解的患者，以及存在多处转移和/或 RFI<24 个月的患者，可考虑使用二线化疗。由于预后不良，对于无法完全手术切除的多处疾病患者，也应考虑采用创新的治疗方法。
