骨与软组织肉瘤治疗的过去、现在与未来

牛晓辉

doi:10.3969/j.issn.2095-252X.2025.011.001

摘要：This article reviews the evolution of treatment strategies for bone and soft tissue sarcomas,highlighting the shift from amputation-focused approaches to the modern goal of both life and limb preservation.The introduction of multi-agent chemotherapy in the 1970 s increased the 5-year survival rate for osteosarcoma from less than 20%to 60%-70%,paving the way for limb-sparing surgeries,microsurgical reconstruction,and adjuvant radiotherapy to achieve better local control and functional outcomes.Recent advances have centered on four key areas:(1)precision surgery and personalized reconstruction through technologies such as surgical navigation,intraoperative assessment,3D printing,extendable prostheses,and multidisciplinary collaboration;(2)radiotherapy innovations including IMRT/IGRT,proton and carbon ion therapy,and more individualized pre/postoperative and intraoperative applications;(3)improved perioperative chemotherapy regimens,such as VDC/IE for Ewing sarcoma and HD-IFO in relapsed cases,though benefits in soft tissue sarcoma remain limited;(4)Emerging value of targeted and immunotherapies in select subtypes,including VEGFR-TKIs,MDM2 inhibitors,TRK inhibitors,EZH2 inhibitors,and RANKL inhibitors,with immunotherapy combinations drawing increasing attention.Current challenges include limited survival gains,subtype heterogeneity,small study cohorts,unclear mechanisms of metastasis and drug resistance,and treatment-related toxicity and functional loss.Future directions emphasize the use of AI and big data to confirm diagnosis and decision-making,adoption of multi-omics and liquid biopsy for precise patient stratification and dynamic monitoring,exploration of cell/gene and combination therapies,and acceleration of clinical translation through high-quality trials and integration of medical and engineering innovations to achieve safer,more effective,and individualized long-term treatment outcomes.