Conclusion
Despite progress made in pathology, imaging and local control modalities coordinated by specialist sarcoma multidisciplinary centers, AYA patients with primary bone sarcomas continue to experience inferior outcomes. The reasons are multifactorial, including aggressive complex biology that remains ill-understood as well as reduced access to novel therapeutics and clinical trials along with unique psychosocial issues. There is now international consensus supporting standardized first line treatment for ES and OS. With evolving modern day imaging techniques (WB-MRI, FDG-PET/CT) and new RT and surgical approaches, local treatment should be tailored to the patient and multidisciplinary collaboration is crucial. New therapeutic agents show promise for AYA sarcomas. The challenge is to explore what value these agents may bring to first-line therapy and how they can be best delivered alongside standard of care treatments. Their inclusion into large randomized phase 3 international trials, along with the validation of biomarkers that signal refractory disease and can reliably predict response is required to fully evaluate their potential.