British Medical Bulletin 52:826-843 (1996)
© 1996 The British Council
research-article |
Problems and controversies in the management of childhood sarcomas
Division of Oncology, The Children's Hospital of Philadelphia,and Departmetn of Pediatrics, University of Pennyslvania School of Medicine Philadelphia, Pennyslvania, USA
Richard B Womer, Division of Oncology, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennyslvania School of Medicine, Philadelphia, PA 19104, USA.
Abstract
Multidisciplinary care and advances in chemotherapy have dramatically improved the prognosis of paediatric sarcoma patients, but much work remains. There are new techniques for molecular diagnosis of Ewing's sarcomas and alveolar rhabdomyosarcomas, with molecular techniques of staging and subclassification under development. Osteosaracoma is a clinically heterogeneous disease which continues to resist biologic diagnosis, classification, or staging. In chemotherapy, the roles of ifosfamide and doxorubicin in rhabdomyosarcoma treatment remain unclear. While many children with metastatic or recurrent sarcomas undergo massive therapy with peripheral stem cell or autologous marrow resuce, the efficacy of these manoeuvres is debatable. Osteosarcoma apperas to respond best to regimens containing doxorubicin and cisplatin, while the roles of alkylating agents, high-dose methotrexate, and carboplatin remain unclear. Ewing's sarcoma treatment increasingly includes surgery because of the risk of secondary osteosarcoma after radiation. Most osteosarcoma patients now have limb-sparing excisions, though amputation may provide better function and cosmesis with less risk of complications in some patients. The role of multimodal treatment including chemotherapy for the miscellaeous soft tissue sarcomas remains uncertain.