Diagnosis and treatment of bone sarcomas

Abstract

Bone sarcomas are primary, non-epithelial, malignant neoplasms that present a variety of malignancy grades; usually high-grade. Some bone sarcomas are purely osteolytic, while other produce bone or cartilaginous tissue, or mixed osteolytic/osteoblastic matrix. The most common bone sarcomas are osteosarcoma, Ewing’s sarcoma and chondrosarcoma. They usually occur in children or young adults and develop in the extremities; mainly the distal femur and the pelvis. The most common symptoms are pain and the presence of a palpable enlarging mass. Plain radiographs are important at the primary work-up in every patient with prolonged bone pain. Magnetic resonance imaging (MRI) is the imaging modality of choice for the diagnostic evaluation of the tumor, its exact location, its relation with the adjacent anatomical structures, intramedullary progression and outside of bone expansion. Except from the local identification of the tumor, disease staging also includes computer tomography (CT) of the chest, of the upper and lower abdomen and the retroperitoneal space, and bone scintigraphy. Wide surgical resection (with tumor-free margins) is the main therapeutic approach, in combination with adjuvant treatment (pre- and postoperative) individualized for each patient. Multidisciplinary approach to these patients is necessary.