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This algorithm organizes treatment of primary bone sarcoma by histology, separating osteosarcoma, Ewing sarcoma and chondrosarcoma, with a final branch for metastatic or relapsed disease. A key principle is that osteosarcoma and Ewing sarcoma are chemosensitive, whereas chondrosarcoma is largely resistant to chemotherapy and radiation.
Localized osteosarcoma is treated with curative intent using neoadjuvant MAP (high-dose methotrexate, doxorubicin and cisplatin), then resection, then adjuvant MAP. Localized Ewing sarcoma is treated with interval-compressed VDC/IE followed by local control, with maintenance per protocol. Chondrosarcoma is managed with wide surgical resection, since chemotherapy and radiation are generally ineffective. For metastatic or relapsed disease, the chart lists regorafenib as an antiangiogenic option (REGOBONE), and for Ewing sarcoma, irinotecan plus temozolomide or high-dose ifosfamide. Histology therefore determines whether systemic therapy has a central role or whether surgery alone is the mainstay of curative treatment.
Background reading: Sarcomas board review notes.
Osteosarcoma, Ewing sarcoma, and chondrosarcoma pathways. Starting point: Primary bone sarcoma by histology. Full background: Sarcomas notes.
Simplified board-prep scaffold; verify against current guidelines and primary literature. Chondrosarcoma is largely chemo/RT-resistant: surgery is the mainstay; osteosarcoma and Ewing are chemosensitive.