UK guidelines for the management of bone sarcomas

Overview

These UK guidelines set out the recommended pathway for patients with suspected or confirmed primary bone sarcoma, from first presentation to long-term follow-up. They stress that care should be delivered by specialist sarcoma multidisciplinary teams.

Referral and diagnosis

Persistent, unexplained bone pain, particularly at night, or a suspicious lesion on imaging should prompt urgent investigation. Plain radiographs are the first test. When a sarcoma is suspected, the patient should be referred to a specialist centre before biopsy. Local staging relies on MRI of the whole affected bone, and systemic staging includes chest imaging.

Biopsy

Biopsy should be planned with, and ideally performed at, the centre that will carry out definitive surgery, so the biopsy tract can be removed later. Specialist pathology review, including molecular testing where relevant, is essential.

Treatment

Surgery aims for complete removal with adequate margins, with limb-sparing procedures preferred when oncologically safe. Chemotherapy is central for osteosarcoma and Ewing sarcoma. Radiotherapy has a role in Ewing sarcoma and in tumours that cannot be fully removed. Chondrosarcoma is treated mainly with surgery.

Follow-up and rehabilitation

Regular follow-up looks for local recurrence and lung metastases and monitors late effects of treatment. Rehabilitation and psychosocial support are part of care.