Bone tumor treatment changed considerably during past decades. Due to improvements in basic research in the areas of tumor biology, tumor detection and imaging, surgical procedures and development of modern surgical instruments, discovery and use of new technical equipment, and especially in the use of chemotherapy and radiotherapy, significant progress has been achieved. About 100 new patients with primary bone tumor (both benign and malignant) are discovered in Croatia and treated at the Department of Orthopedic Surgery, Clinical Hospital Center Zagreb and Zagreb University School of Medicine per year, and almost a half of them (45%) are younger than 20 years. The most common benign bone tumors are osteochondroma, simple (juvenile) bone cyst, and osteoid osteoma, and the most common malignant bone tumors are osteosarcoma and Ewing’s sarcoma. Bone tumors are localized mostly in the long bones (femur, tibia, humerus), and the knee joint region is the most common site of tumors.
Patient history and examination with laboratory and imaging methods remain the essence in tumor diagnosis. A conventional X-ray examination must be the first and the most important part in tumor imaging, followed by bone scan, CT, MRI, ultrasound, and histological or cytological analysis. The biopsy, as the most accurate method in tumor diagnosis must be performed as the last diagnostic procedure. Cytological analysis is useful in tumors with soft tissue.
An individual approach to patient is essential in order to choose the most suitable surgical treatment for bone tumor. Depending on the tumor type, location and other patient-related risk factors, one of the various forms of surgical therapy should be chosen. Limb salvage surgery means “en-bloc” tumor resection with the affected part of the bone through a healthy tissue and defect reconstruction, with preservation of the affected limb; this procedure is performed nowadays in about 85% of patients with malignant bone tumors. Reconstruction can be biologic (with bone auto- or homotransplant) or with foreign material (i.e. endoprosthesis or bone cement). Soft tissue reconstruction is a great challenge in this part of a treatment, and complications are not rare. Amputation still has and will have in the future an important place in treating patients with malignant bone tumor.
Decision on additional chemo- and/or radiotherapy should be made between pediatric, oncology and orthopedic surgeons, according to international guidelines.
Future devolvement in treating patients with bone tumors points into supporting and/or establishing reparative procedures. Bone and surrounding tissue regeneration is always better than defect reconstruction.Liječenje tumora kosti posljednjih se desetljeća znatno promijenilo. Zahvaljujući napretku temeljne znanosti u području biologije tumora, boljoj mogućnosti otkrivanja i snimanja tumora, kirurškim metodama i suvremenim kirurškim instrumentima, otkriću i primjeni nove tehničke opreme, a posebice kemoterapiji i radioterapiji postignuto je mnogo. U Hrvatskoj se godišnje otkrije oko 100 novih bolesnika s primarnim tumorom kosti (dobroćudnih i zloćudnih) i toliko ih se liječi u Klinici za ortopediju Kliničkog bolničkog centra Zagreb i Medicinskog fakulteta Sevučilišta u Zagrebu, a gotovo polovica tih bolesnika (45%) mla|a je od 20 godina. Najčešći dobroćudni tumori kosti su osteohondrom, jednostavna (juvenilna) koštana cista i osteoidni osteom, dok su najčešći zloćudni tumori kostiju osteosarkom i Ewingov sarkom. Tumori kostiju uglavnom se nalaze u dugim kostima (femur, tibija, humerus), a najčešće sijelo tumora je područje koljenoga zgloba.
Povijest bolesti i pregled upotpunjen laboratorijskim i radiološkim nalazima i dalje su temelj za postavljanje dijagnoze tumora. Konvencionalni rtg pregled mora biti prvi i najvažniji dio snimanja tumora, nakon čega slijede scintigrafija, CT, MRI, ultrazvuk te histološka ili citološka analiza. Biopsija je najtočnija metoda u dijagnozi tumora i zadnji dijagnostički postupak koji se mora obaviti. Citološka analiza je korisna kad je riječ o tumorima mekog tkiva.
Individualni pristup bolesniku nužan je za izbor najprikladnijeg oblika kirurškog liječenja tumora kosti. Izbor - kirurške terapije ovise o vrsti tumora, sijelu i ostalim čimbenicima rizika svakog pojedinog bolesnika. Kirurgija spašavanja ekstremiteta znači resekciju tumora ’en bloc’ sa zahvaćenim dijelom kosti kroz zdravo tkivo i rekonstrukcijom defekta, uz sačuvanje zahvaćenog ekstremiteta; taj se postupak danas primjenjuje u oko 85% bolesnika sa zloćudnim tumorima kosti. Rekonstrukcija se može izvesti biološki (auto- ili homotransplantatom) ili stranim materijalom (endoprotezom ili koštanim cementom). Rekonstrukcija mekog tkiva velik je izazov u tome dijelu liječenja i komplikacije nisu rijetka pojava. Amputacija još uvijek ima i ubuduće će imati važno mjesto u liječenju bolesnika sa zloćudnim tumorima kosti.
Odluku o naknadnoj primjeni kemo- i/ili radioterapije zajedno trebaju donijeti pedijatar, onkolog i ortopedski kirurg u skladu s me|unarodnim smjernicama.
Daljnja zadaća u liječenju bolesnika s tumorima kosti jest podupirati i/ili odrediti reparativne postupke. Regeneracija kosti i okolnoga tkiva uvijek je bolja solucija od rekonstrukcije defekta
