Guidelines on the management of bone sarcoma were published on April 21, 2022 by the Sarcoma European Latin-American Network (SELNET), in Critical Reviews in Oncology/Hematology.
Neoadjuvant chemotherapy is recommended. The MAP regimen (doxorubicin/cisplatin/high-dose methotrexate) is most frequently used in children and young adults, while cisplatin plus doxorubicin is an option for patients older than 40 years.
Standard surgical therapy is wide resection (with negative margins), with limb salvage whenever possible.
Postoperative adjuvant chemotherapy should be administered using the same drugs as in the neoadjuvant setting, for at least two further cycles.
Wide surgical resection without systemic treatment is the standard approach. Marginal resection is acceptable in selected cases.
The general strategy for the treatment of localized Ewing sarcoma includes neoadjuvant chemotherapy, then wide surgical resection of the primary tumor and/or radiation therapy, followed by adjuvant chemotherapy.
Atypical cartilaginous tumors/grade 1 chondrosarcoma of long bones can be managed with intralesional extended curettage (large cortical window, high-speed burr) with or without local adjuvant therapy such as phenol or cryotherapy, and reconstruction with cement or bone graft.
Grade 2 and 3 chondrosarcoma, and chondrosarcomas of any grade that are located in the pelvis or axial skeleton, should be surgically excised with wide margins.
Giant-cell Tumor of Bone
Treatment options include wide surgical resection and intralesional extended curettage with adjuvant therapy, such as phenol, cement, and cryotherapy in carefully selected cases.
For more information, please go to Bone Sarcoma Guidelines.
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Cite this: Bone Sarcoma Clinical Practice Guidelines (SELNET, 2022) - Medscape - Apr 29, 2022.