骨肿瘤规范化治疗与研究展望

近30年来，骨与软组织肿瘤的治疗在整个骨科领域中所占的比重虽然不大，但其进步是非常显著的。随着化疗的引入，手术技术的提高，综合治疗和规范化治疗的倡导，骨与软组织肿瘤的诊治水平和策略有了长足的发展。对于常见的骨与软组织原发肿瘤，治疗的总体方案归结为以手术为主导，放化疗为辅助的综合治疗，患者的生存率较前大大提高，复发率明显降低，功能评定显著改善。在当前的总体治疗策略上，我们仍然一贯地推崇骨肿瘤的规范化治疗，并不遗余力地在全国进行推广。倡导规范化、推动规范化、推崇创新研究，是目前骨肿瘤学科的鲜明特点。

Prospects of the standardized treatment and research of neoplasms

With the introduction of chemotherapy, the improvement of surgical techniques and the advocation of comprehensive and standardized treatment, great progresses have been made in the treatment of bone and soft tissue tumors. Comprehensive treatment strategy is an ideal choice for common primary bone and soft tissue tumors with surgery as the main therapy and chemoradiotherapy as the adjuvant therapy. The standardized treatment is regarded as the best strategy. The histological reaction in the neoadjuvant chemotherapy is taken as the principal method to predict the survival rate. For the patients with osteosarcoma, surgery and chemotherapy are included in the standardized treatment. It is an unclear concept of＂unresectable tumors＂. The tumor that can be resected by a surgeon may be unresectable for another, and it depends on how much the patient could accept the adverse effects on his or her functions. The prognosis could be predicted by the high expressions of the interferonα/β. How many metastatic lesions are there？ Is it possible to resect all these lesions completely？ All the factors may affect the prognosis. The wide resection combined with the preoperative chemotherapy is recommended in the treatment of resectable osteosarcoma in its progressive stage. As to the patients with unresectable metastatic tumors, the chemotherapy is a good choice. The primary tumors are evaluated, and then a suitable approach is chosen to control the local condition. The radiotherapy is the main treatment method for the patients with tumors that could not be resected by surgery. The dedifferentiated chordoma is treated according to the National Comprehensive Cancer Network （ NCCN ） guideline. It is better for the patients with metastatic giant cell tumors to undergo the treatment of intracapsular resection. Non-surgical treatment or radiotherapy is recommended for the patients with unresectable tumors. The radiotherapy can be taken as an adjutant therapy in the comprehensive treatment of bone and soft tissue tumors. For the patients who cannot accept surgery, radiotherapy is the last choice. In order to ensure the beneifts of the patients and the constant progress of the surgeons in the ifeld of academics, the principle of all the treatment methods and techniques should be in consistent with that in the treatment of bone and soft tumors.