从2017 NCCN新版骨肿瘤指南看骨肉瘤、尤文肉瘤的诊治进展和未来方向

Recent advances and future directions in the treatment of osteosarcoma and Ewing sarcoma: insights from 2017 National Comprehensive Cancer Network bone cancer guideline update

近期,美国国家综合癌症网络（National Comprehensive Cancer Network,NCCN）更新了骨肿瘤临床实践指南,目前为2017年第二版。骨肉瘤、尤文肉瘤方面,与2016年第二版相比,除了对于影像学检查、尤文肉瘤命名等加以明确、规范外,主要改动即对于新辅助化疗反应差的骨肉瘤患者,术后化疗方案推荐中＂考虑更换化疗方案（2B）＂改为了＂维持原方案或更换化疗方案（2B）＂,其余改动不大。

National Comprehensive Cancer Network（ NCCN） of the united states has updated its 2 nd version of 2017 guideline on the clinical management of bone cancer. Some minor revisions have been updated in terms of the radiological examination and the Ewing sarcoma terminology, and a major revision regarding the change of ‘considering second line chemotherapy（ 2 B）＇ to ‘maintain original chemotherapy or consider second line chemotherapy（ 2 B）＇, while no remarkable renewals were seen in the remaining content of NCCN bone cancer guideline. Given the effortless endeavor toward the clinical and basic research, the prognosis of primary high-grade bone malignancy has reached a plateau in the past three decades. In this article, we aim to discuss, together with recent evidence, the updated NCCN bone cancer guideline from chemotherapy, molecular biomarker, target agents, metastatic heterogeneity and metastasectomy, and suggest our future directions for the treatment of osteosarcoma and Ewing sarcoma.