Current concepts in the management of disseminated malignant bone disease in childhood

Disseminated malignant disease should be approached with the intention of curing the patient. This requires a multidisciplinary approach. Essential to the successful application of multidisciplinary treatment is the administration of effective chemotherapy, which may achieve reduction in both microscopic disease and overt tumour. In Ewing's sarcoma, the latter should be treated also by irradiation. Limited areas of bulk tumour that have failed to respond or have responded only partially may be removed surgically. Chemotherapy and radiation therapy should be used extensively for palliation; surgery may be required occasionally for control of pain. The decision to treat palliatively should be reached only after patients have received multidisciplinary consultation.