Damron T A, Pritchard D J
Department of Orthopedics, State University of New York Health Science Center, Syracuse, USA.
Oncology (Williston Park). 1995 Apr;9(4):327-43; discussion 343-4, 347-50.
The evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to intensive multiagent adjuvant chemotherapy, with better imaging modalities and reconstructive techniques also playing an important role. The current standard treatment for nonmetastatic osteosarcoma includes neoadjuvant chemotherapy, limb-sparing "wide" surgical resection, and reconstruction of the defect. Approximately 80% of patients are spared amputation. Limb salvage should be considered when an adequate surgical margin is attainable without significant neurovascular compromise and the surgical reconstruction is likely to provide better function than amputation. Because a good chemotherapeutic response is an important favorable prognosticator, much recent attention has been focused on predicting response preoperatively to allow closer surgical margins. Aggressive surgical treatment of pulmonary metastases has also been of measurable benefit.
在过去20年中，骨肉瘤的评估和治疗有了很大进展，预后也相应地有了显著改善。很大程度上，预后的改善归因于强化多药辅助化疗，更好的成像方式和重建技术也发挥了重要作用。目前非转移性骨肉瘤的标准治疗包括新辅助化疗、保肢“广泛”手术切除以及缺损重建。约80%的患者避免了截肢。当能够获得足够的手术切缘且不造成明显的神经血管损伤，并且手术重建可能比截肢提供更好的功能时，应考虑保肢。由于良好的化疗反应是一个重要的有利预后因素，最近很多注意力都集中在术前预测反应上，以便获得更窄的手术切缘。积极的手术治疗肺转移也有明显益处。
