Conclusion
Despite progress made in pathology, imaging and local control modalities
coordinated by specialist sarcoma multidisciplinary centers, AYA
patients with primary bone sarcomas continue to experience inferior
outcomes. The reasons are multifactorial, including aggressive complex
biology that remains ill-understood as well as reduced access to novel
therapeutics and clinical trials along with unique psychosocial issues.
There is now international consensus supporting standardized first line
treatment for ES and OS. With evolving modern day imaging techniques
(WB-MRI, FDG-PET/CT) and new RT and surgical approaches, local treatment
should be tailored to the patient and multidisciplinary collaboration is
crucial. New therapeutic agents show promise for AYA sarcomas. The
challenge is to explore what value these agents may bring to first-line
therapy and how they can be best delivered alongside standard of care
treatments. Their inclusion into large randomized phase 3 international
trials, along with the validation of biomarkers that signal refractory
disease and can reliably predict response is required to fully evaluate
their potential.