When pediatric, adolescent, and young adult patients present with a bone sarcoma, treatment decisions, especially after relapse, are complex and require a multidisciplinary approach. This review presents scenarios commonly encountered in the therapy of bone sarcomas with the goal of objectively presenting a consensus, multidisciplinary management approach. Little variation was found in the authors' group with respect to local control or systemic therapy. Clinical trials were universally prioritized in all settings. Decisions regarding relapse therapies in the absence of a clinical trial had very minor variations initially, but a consensus was reached after a literature review and discussion. This review presents a concise document and figures as a starting point for evidence-based care for patients with these rare diseases. This framework allows prospective decision making and prioritization of clinical trials. It is hoped that this framework will inspire and focus future clinical research and thus lead to new trials to improve efficacy and reduce toxicity.
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Damon R. Reed and Michael S. Isakoff received funding from the National Pediatric Cancer Foundation (www.nationalpcf.org) for this work. Michael S. Isakoff also received funding from the Reid R. Sacco Adolescent and Young Adult Cancer Alliance. Masanori Hayashi was supported from the SARC Sarcoma SPORE Career Development Award (5U54CA168512-02).
Reed, Damon R.; Hayashi, Masanori; Wagner, Lars M.; Binitie, Odion; Steppan, Diana A.; Brohl, Andrew S.; Shinohara, Eric T.; Bridge, Julia A.; Loeb, David M.; Borinstein, Scott C.; and Isakoff, Michael S., "Treatment Pathway of Bone Sarcoma in Children, Adolescents, and Young Adults" (2017). Pediatrics Faculty Publications. 226.