The history,progress and future of bone and soft tissue sarcoma treatment

NIU Xiao-hui

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

Abstract：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 1970s 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.