Department of Orthopedics and Trauma Surgery, Helios Hospital Hildesheim, Germany; Department of Orthopedics and Trauma Surgery, University Hospital Cologne, Germany; Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Germany; Department of Pediatric Oncology, University Hospital Cologne, Germany.
Dtsch Arztebl Int. 2023 Jun 16;120(24):405-412. doi: 10.3238/arztebl.m2023.0079.
Osteosarcoma and Ewing's sarcoma in children and adolescents require age-specific interdisciplinary diagnosis and treatment to achieve optimal therapeutic outcomes.
The diagnosis and treatment of malignant bone tumors in childhood and adolescence are presented in the light of publications retrieved by a selective search, pertinent guidelines, and the authors' extensive experience in an interdisciplinary cancer center.
Bone sarcomas make up approximately 5% of all malignancies in children and adolescents; the most common types are Ewing's sarcoma and osteosarcoma. Patients are often not referred to a specialized center until long after the onset of symptoms, as they and their physicians rarely consider the possibility of a bone tumor, and the symptoms are often trivialized. Bone pain of unknown origin, swelling, and functional limitations should be investigated with conventional x-rays. Lesions of unclear origin should be biopsied after a meticulous clinical and radiologic evaluation. Multimodal treatment consists of neo - adjuvant chemotherapy, limb-preserving resection if possible, and radiotherapy where indicated. In multicenter studies, patients with osteosarcoma achieve event-free survival in 64% of cases if their disease is localized, and 28% if it is metastatic; the corresponding figures for patients with Ewing's sarcoma are 80% and 27%, respectively.
With implementation of the current treatment recommendations, most children and adolescents with malignant bone tumors can be treated successfully with curative intent. These patients should be referred to a sarcoma center for diagnosis and treatment.
儿童和青少年的骨肉瘤和尤文肉瘤需要特定于年龄的跨学科诊断和治疗，以实现最佳的治疗效果。
根据选择性搜索、相关指南和作者在跨学科癌症中心的丰富经验，介绍了儿童和青少年恶性骨肿瘤的诊断和治疗。
骨肉瘤约占儿童和青少年所有恶性肿瘤的 5%；最常见的类型是尤文肉瘤和骨肉瘤。患者通常在出现症状很久后才被转介到专门的中心，因为他们和他们的医生很少考虑到骨肿瘤的可能性，而且症状通常被轻视。不明原因的骨痛、肿胀和功能受限应通过常规 X 光进行检查。对于来源不明的病变，应在进行细致的临床和影像学评估后进行活检。新辅助化疗、尽可能保肢切除和必要时放疗构成了多模式治疗。在多中心研究中，如果局部病变，骨肉瘤患者的无事件生存率为 64%，如果转移病变，无事件生存率为 28%；尤文肉瘤患者的相应数字分别为 80%和 27%。
通过实施当前的治疗建议，大多数患有恶性骨肿瘤的儿童和青少年可以成功地进行治愈性治疗。这些患者应转介到肉瘤中心进行诊断和治疗。
