[Surgery of primary malignant bone tumors]

Area of Science:

• Orthopedic Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Primary malignant bone tumors encompass diverse entities requiring tailored treatment strategies.
• Surgical resection is a cornerstone for managing most primary bone malignancies.
• Treatment approaches range from surgery alone to combined modality therapies.

Purpose of the Study:

• To review the role of surgery, radiotherapy, and chemotherapy in managing primary malignant bone tumors.
• To highlight the efficacy of combined modality treatments for specific bone tumor types.
• To discuss the evolving role of surgery in local control for tumors like Ewing's sarcoma.

Main Methods:

• Review of treatment paradigms for primary malignant bone tumors.
• Analysis of the impact of surgery, radiotherapy, and chemotherapy on patient survival.
• Comparison of treatment efficacy across different bone tumor diagnoses.

Main Results:

• Surgery alone is sufficient for some tumors like primary osseous fibrosarcoma.
• Combined modality therapy (surgery, radiotherapy, chemotherapy) is crucial for osteosarcomas and Ewing's tumors.
• Systemic chemotherapy significantly improves survival rates for Ewing's tumor (from <10% to >60%) and osteosarcoma (10-20% 5-year survival without it).
• Radiotherapy is generally less effective than surgery for local control but indicated when surgical margins are compromised.
• Treatment for malignant fibrous histiocytoma of bone mirrors osteosarcoma, with both local therapies and chemotherapy used.

Conclusions:

• Surgical resection remains vital for primary malignant bone tumors.
• Combined modality approaches, particularly with systemic chemotherapy, are essential for improving outcomes in high-grade osteosarcomas and Ewing's tumors.
• Treatment decisions, especially regarding local control modalities like surgery versus radiotherapy, should be individualized based on tumor type and surgical feasibility.