Introduction
Primary tumors arising in bone are characterized by an almost unique age
incidence pattern, incompletely understood biology, complex and morbid
treatments and patient outcomes in need of improvement. In the
adolescent and young adult (AYA) age range, the two most common bone
sarcomas are osteosarcoma (OS) and Ewing sarcoma (ES) of bone. While a
significant proportion of young people with these diseases can be cured,
their lives are often associated with lifelong consequences, especially
in, but not limited to, physical functioning, so that survivorship
issues are an essential consideration in providing care for AYA with
bone sarcoma. Achieving improvements in survival has proved challenging
despite greater levels of international collaboration in recent decades.
This is likely multifactorial, including unequal access to expert
multidisciplinary care. Recent observations of activity of new systemic
agents against advanced disease hold hope for the future. A
well-established multi-modality treatment approach for OS and ES focuses
on systemic chemotherapy integrated with management of the primary tumor
by surgery, radiotherapy (RT) or both. The challenge for specialists is
to optimize these treatments to ensure the greatest number of young
people survive with least long-term cost.