From the Sarcoma Department, Moffitt Cancer Center, Tampa, FL (Alexander, Binitie, Letson, and Joyce), and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH (Alexander).
J Am Acad Orthop Surg. 2021 Oct 15;29(20):e993-e1004. doi: 10.5435/JAAOS-D-20-00838.
Osteosarcoma is the most common primary bone sarcoma and affects both children and adults. The cornerstone of treatment for patients with localized and oligometastatic disease remains neoadjuvant chemotherapy, surgical resection of all sites of disease, followed by adjuvant chemotherapy. This approach is associated with up to an 80% 5-year survival. However, survival of patients with metastatic disease remains poor, and overall, osteosarcoma remains a challenging disease to treat. Advances in the understanding of molecular drivers of the disease, identification of poor prognostic factors, development of risk-stratified treatment protocols, successful completion of large collaborative trials, and surgical advances have laid the ground work for progress. Advances in computer navigation, implant design, and surgical techniques have allowed surgeons to improve patients' physical functional without sacrificing oncologic outcomes. Future goals include identifying effective risk stratification algorithms which minimize patient toxicity while maximizing oncologic outcomes and continuing to improve the durability, function, and patient acceptance of oncologic reconstructions.
骨肉瘤是最常见的原发性骨肉瘤，影响儿童和成人。局部和寡转移疾病患者的治疗基石仍然是新辅助化疗、所有病变部位的手术切除，然后是辅助化疗。这种方法的 5 年生存率高达 80%。然而，转移性疾病患者的生存率仍然很差，总的来说，骨肉瘤仍然是一种具有挑战性的疾病。对疾病分子驱动因素的理解、确定不良预后因素、制定风险分层治疗方案、成功完成大型合作试验以及手术进展方面的进展为取得进展奠定了基础。计算机导航、植入物设计和手术技术的进步使外科医生能够在不牺牲肿瘤学结果的情况下改善患者的身体功能。未来的目标包括确定有效的风险分层算法，在最大程度地提高肿瘤学结果的同时最大限度地降低患者毒性，并继续提高肿瘤重建的耐用性、功能和患者接受度。
