Recurrent, refractory, metastatic and/or unresectable pediatric sarcomas: Treatment options for young people 'off the roadmap'

Although sarcoma surgery is very important for cancer control, it is always possible or practical to offer in some situations, including sarcoma recurrences, metastatic disease and/or inacceptable loss of function. We review some pragmatic approaches and examples of how to balance indications, risks and alternatives to control cancer in young people with sarcomas that are no longer using 'front line' therapy. Radiotherapy combined with chemotherapy and outpatient 'continuation' chemotherapy regimens using drugs that cause less alopecia can improve function and quality of life. Some effective strategies to help techniques performed in interventional radiology and percutaneous nerve blocks. Family centered care and effective problem solving of difficult issues can be greatly facilitated by consultation with a multidisciplinary team experienced in the management of very difficult cases. Treatment of young people with recurrent, relapsed and/or metastatic sarcoma still protocol and persistent advocacy is required for the young person for whom oure may not possible. A reduction of suffering and assistance in writing more chapters of a rich life narrative is the goal.