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Published on: September 9, 2020
[Surveillance in patients with bone sarcomas. When, how, and for how long?]
H R Dürr1, P-U Tunn, Y Bakhshai
1Schwerpunkt Tumororthopädie, Orthopädische Klinik, Klinikum der LMU München, Campus Grosshadern, Marchioninistraße 15, 81377, München, Deutschland, hans_roland.duerr@med.uni-muenchen.de.
Background:
The overall survival in patients with typical bone sarcomas such as Ewing-sarcoma, osteosarcoma, or chondrosarcoma exceeds 60% in localized disease after 5 years. Local or systemic recurrence detected by surveillance may not only improve or solve the local problem but also significantly improves the prognosis of the patient. Thus, surveillance seems to be justified.
Objectives:
As a consequence, the questions of how and how long surveillance should be performed must be answered.
Methods:
A literature review of the last 15 years, discussion of review articles, and multidisciplinary expert opinions as published in major multinational studies.
Results:
The decision which surveillance scheme outside of clinical studies might be appropriate largely depends on the prognostic benefit of early detection of local or systemic recurrence. The detection rate of local recurrence by the patient himself is high in extremities. A systematic technical examination for the detection of pulmonary metastases is controversial because the chance of cure in systemic progression is generally unfavorable. Whether the earlier detection of both types of recurrence due to reduced examination intervals and/or the use of a CT or MRI is significantly advantageous, remains unproven. The duration of surveillance is even less clear. Both local and systemic recurrences may be seen more than 10 years after treatment of the primary tumor.
Conclusion:
Surveillance makes sense in any case, since the detection of a local recurrence is possible already with methods easy to apply. Whether and to what extent local imaging is used is left to the individual case. Under the current conditions in Germany, local (e.g., MRI) imaging at least every 6 months during the first 2-3 years, then possibly on an annual basis is recommended. There is no evidence-based support for the decision whether and when an X-ray of the chest is indicated and whether and when a CT scan should be performed. Striking is the lack of prospective studies on surveillance concerning both patient- and economically relevant aspects of tumor therapy.
