The treatment of the patient with a localised primary bone tumour, particularly in youth, is aimed at cure. This is usually effected by primary chemotherapy, where the patient undergoes several cycles of a multiple chemotherapy drug regime and then (after shrinkage of the tumpour by this means) surgery follows. If the chemotherapy has been useful in causing tumour shrinkage, then more chemotherapy may well be advised after the operation is over - and cure is the target.
Radiotherapy may have a role in tumours that are not straightforward to operate e.g. vertebral/spinal tumours.
Occasionally, where there is early metastatic disease e.g one or a few lung metastases from osteogenic sarcoma, surgical excision of these metastases may still allow cure and the timing of such surgery is carefully integrated into the chemotherapy regime.
Similarly, when an osteogenic sarcoma patient relapses some time after the whole therapy regime is completed, with lung metastatic nodules (but once again only with a single or a few) , then surgical excision or cyberknife to these nodules may be part of a 'salvage' regime that will include further (but different) chemotherapy - again, all aimed cure.
For relapsed Ewing's sarcoma, the 'salvage' chemotherapy regime may be followed by a 'high dose' chemotherapy treatment and then autologous (nowadays a peripheral blood stem cell) transplant. (In this technique, a very high dose of chemotherapy is given that is sufficient to 'knock out' the tumour cells that survive but also, as a sideeffect, most vulnerable dividing cell population in the body - viz. the bone marrow, and the patient is then rescued from bone marrow failure by the re-infusion of their own bone marrow progenitor cells that were harvested earlier).
Plowman Oncology London (e-mail: postmaster@pnplowman.demon.co.uk)
