Zusammenfassung
Knochensarkome sind im Gegensatz zu den häufig auftretenden benignen Knochentumoren
und tumorähnlichen Knochenläsionen sehr selten und verursachen daher häufig diagnostische
und therapeutische Schwierigkeiten. Dieser Beitrag hat zum Ziel, dem Leser die Diagnostik
und zumeist multimodale Therapie der häufigsten Knochensarkome wie Osteosarkom, Ewing-Sarkom
und Chondrosarkom näherzubringen.
Abstract
Bone sarcomas are extremely rare representing approximately 0.2% among all cancer
types. Due to the rarity of these tumors both the patients and the physicians can
overlook or misinterpret the first often unspecific symptoms of these tumors (pain,
limping and swelling). Therefore, radiographic examination (X-ray and/or MRI) of the
involved region in case of inexplicable symptoms is strongly recommended. The most
common primary malignant bone tumor entity is osteosarcoma, followed by chondrosarcoma
and Ewing sarcoma. Osteosarcomas and Ewing sarcomas occur predominantly in children,
adolescents and young adults, while chondrosarcomas primarily affect older patients.
Most of the tumors are located in the extremities and the pelvis and in about 90%
of cases the surgical treatment can be performed by means of a limb-sparing wide resection.
An endoprosthetic or biological reconstruction of the resulting defect, depending
on several patient- und tumor-related factors, usually is necessary. Apart from the
surgical treatment, patients with osteosarcoma and Ewing sarcoma require a pre- and
postoperative chemotherapy, while Ewing sarcoma patients often undergo radiation therapy
as well – in some cases as the only local therapy option. Regular follow-up examinations
are required after the completion of treatment for the early detection and management
of local and/or systemic recurrences. Diagnosis and therapy of these rare tumors must
be obtained by an interdisciplinary approach for optimal patient care (i.e. oncologist,
radiologists, pathologists, orthopaedic surgeons, radiotherapists). Without an interdisciplinary
proceeding the risk of mistakes increases significantly, which can have grave consequences
on the patients’ prognosis and functional outcome. Therefore, the centralized treatment
of these patients in specialized sarcoma centres is recommended.
Schlüsselwörter
Knochensarkom - Diagnostik - Therapie - Tumorresektion
Key words
bone sarcoma - diagnosis - therapy - tumor resection
