Salvati M, Ciappetta P, Raco A
Department of Neurological Sciences-Neurosurgery, La Sapienza University of Rome, Italy.
Cancer. 1993 Apr 1;71(7):2210-6. doi: 10.1002/1097-0142(19930401)71:7<2210::aid-cncr2820710708>3.0.co;2-w.
Osteosarcomas are typically long bone tumors and rarely affect the skull, with most articles reporting single cases. As elsewhere in the body, these lesions may be classified as primary or secondary, chiefly post-Paget and post-radiation therapy.
The authors reviewed the osteosarcomas of the skull diagnosed at the Division of Neurosurgery of "La Sapienza" University of Rome. The patients were placed into two groups, according to the treatment received (prechemotherapeutic era and chemotherapeutic era). In the last five patients, a diagnostic-therapeutic protocol was adopted.
The most effective investigations are plain radiographs, computed tomography (CT) with bone windows, and magnetic resonance imaging (MRI), with the latter two allowing assessment of the extraosseous extent of the disease. Chemotherapy has changed the prognosis dramatically, achieving cure in some cases (especially in de novo osteosarcomas). Before the age of chemotherapy, the median survival length was 16 months, but since its introduction, five of nine patients in this study are alive 2 years after diagnosis. The onset of metastases, chiefly to the lung, does not necessarily imply a poor prognosis. The authors propose a schedule for the diagnosis and treatment of new cases of osteosarcoma of the skull.
Plain radiographs, CT targeted on the bone, and MRI are the most important diagnostic tools. Aggressive chemotherapy together with surgery (eventually including local radiation therapy in nontotal macroscopic surgical removal of the lesions) can drastically modify the prognosis of de novo and post-radiation therapy osteosarcomas.
骨肉瘤通常是长骨肿瘤，很少累及颅骨，大多数文献报道的是单个病例。与身体其他部位一样，这些病变可分为原发性或继发性，主要是佩吉特病后和放射治疗后。
作者回顾了罗马“萨皮恩扎”大学神经外科诊断的颅骨骨肉瘤病例。根据接受的治疗（化疗前时代和化疗时代）将患者分为两组。对最后5例患者采用了诊断-治疗方案。
最有效的检查方法是普通X线片、骨窗计算机断层扫描（CT）和磁共振成像（MRI），后两者可评估疾病的骨外侵犯范围。化疗显著改变了预后，在某些病例中实现了治愈（尤其是新发骨肉瘤）。在化疗时代之前，中位生存时间为16个月，但自引入化疗以来，本研究中的9例患者中有5例在诊断后2年仍存活。转移灶的出现，主要是肺转移，并不一定意味着预后不良。作者提出了颅骨骨肉瘤新病例的诊断和治疗方案。
普通X线片、骨靶向CT和MRI是最重要的诊断工具。积极的化疗联合手术（最终包括在病变未完全肉眼切除时进行局部放射治疗）可显著改变新发和放射治疗后骨肉瘤的预后。
