| Popis: |
Almost all malignant bone tumors in children are either osteogenic sarcomas or Ewing's sarcomas. Their origin and their site are different as well as the course of the disease and its treatment. Amputation or desarticulation in still the best local treatment for osteogenic sarcoma. Irradiation can benefit some patients. Conservative resection, followed by internal prosthesis, is still an experimental procedure. Results of chemotherapy combining high-dose methotrexate and adriamycin have been controversial. Prophylactic pulmonary irradiation seems to lessen the number of metastases. Controlled therapeutic trials are mandatory to assess the efficacy of these complementary treatments. Local cure is obtained in 90% of Ewing's sarcomas by high doses of radiotherapy but with a number of late sequellae. This tumor is also highly chemosensitive. Treatment of the infra-clinical disease by intensive chemotherapy has significantly increased the number of long-term cures. Other therapeutic regimens combining chemotherapy, radiotherapy and limited conservative surgery are now under investigation in an effort to diminish the sequellae without decreasing the number of cures. |
