Bone sarcomas are malignant tumors of bone tissue that most commonly occur in children and adolescents. The two most frequent types of bone sarcomas in pediatric patients are osteosarcoma and Ewing sarcoma. Osteosarcoma usually develops in bones such as the femur, tibia, or humerus, whereas Ewing sarcoma may arise in the pelvis, ribs, spine, or long bones. Treatment of bone sarcomas in children is complex and involves a combination of surgery, chemotherapy, and in some cases radiotherapy.
Treatment is aimed at complete tumor removal, prevention of metastasis, and preservation of function of the affected limb. Early diagnosis and a comprehensive multidisciplinary approach significantly increase the chances of recovery.
Main treatment methods for pediatric bone sarcomas in Belarus
Chemotherapy. Chemotherapy is a key component in the treatment of both osteosarcoma and Ewing sarcoma. Chemotherapeutic agents destroy cancer cells and help reduce tumor size before surgery.
- Neoadjuvant chemotherapy. Administered before surgery to shrink the tumor and facilitate its removal.
- Adjuvant chemotherapy. Given after surgery to eliminate residual cancer cells and reduce the risk of recurrence.
Surgical treatment.
- The goal of surgery is complete excision of the tumor with clear margins.
- Limb-sparing surgery. In most cases, surgeons can remove the tumor while preserving the affected limb. After resection, reconstruction may require an endoprosthesis (artificial bone) or a bone graft.
- Amputation. In rare cases, when the tumor is extensive or invades critical surrounding structures, amputation of the limb may be necessary.
- Reconstructive surgery. Following tumor removal, reconstruction using metallic implants or bone grafts may be performed to restore limb function.
Radiation therapy.
- Radiation therapy is mainly used in the treatment of Ewing sarcoma, as this tumor type is more radiosensitive. Osteosarcoma is generally less responsive to radiation and therefore radiotherapy is used less frequently.
- Local radiation therapy may be administered before or after surgery to reduce tumor size or eradicate residual malignant cells.
- Targeted therapy. In selected cases, targeted agents aimed at specific molecular pathways involved in tumor growth may be used. These approaches are typically applied within clinical trials.
Immunotherapy.
- Research is ongoing into the use of immunotherapy for bone sarcomas. This approach aims to stimulate the patient’s immune system to recognize and destroy cancer cells.
Additional treatment approaches
- Physiotherapy and rehabilitation. After surgery, children often require physiotherapy to restore limb function. This is particularly important after limb-sparing procedures or amputation. Rehabilitation improves mobility, strength, and overall quality of life.
- Psychological support. A cancer diagnosis can be emotionally traumatic for children and their families. Psychological counseling plays an important role in treatment and recovery, helping patients cope with emotional stress and adapt to life changes.
- Nutritional support. Adequate nutrition is essential for recovery. Dietitians may assist families in ensuring sufficient caloric intake and proper nutrition during and after treatment.
Treatment of Ewing sarcoma
- Combination chemotherapy. Treatment usually begins with intensive multi-agent chemotherapy to reduce tumor size and control micrometastatic disease.
- Surgery and/or radiation therapy. Depending on tumor location, surgery, radiation therapy, or a combination of both may be used to achieve local control.
- Adjuvant chemotherapy. Continued after local treatment to eliminate remaining cancer cells and reduce relapse risk.
Life after treatment
- Regular medical follow-up. Long-term follow-up is required after completion of therapy to monitor for recurrence and detect late treatment-related complications.
- Physical adaptation and activity. Children may need to adapt to new physical capabilities, particularly after amputation. Physiotherapists and orthopedic specialists help patients return to active daily life.
- Emotional support and social reintegration. Children and adolescents may experience emotional difficulties related to changes in appearance or physical limitations. Access to psychological support is essential.
Treatment of bone sarcomas in children is a complex, multi-stage process that requires coordinated efforts from a multidisciplinary team, including pediatric oncologists, surgeons, radiologists, and rehabilitation specialists. Early diagnosis and an integrated treatment strategy significantly improve survival outcomes and enable children to return to a fulfilling life. Rehabilitation and emotional support are equally important to ensure long-term well-being and confidence after treatment.
