Osteosarcoma and Ewing sarcoma are bone tumors mostly diagnosed in children, adolescents, and young adults. Despite multimodal therapy, morbidity is high and survival rates remain low, especially in the metastatic disease setting. Trials investigating targeted therapies and immunotherapies have not been groundbreaking. Better understanding of biological subgroups, the role of the tumor immune microenvironment, factors that promote metastasis, and clinical biomarkers of prognosis and drug response are required to make progress. A prerequisite to achieve desired success is a thorough, systematic, and clinically linked biological analysis of patient samples, but disease rarity and tissue processing challenges such as logistics and infrastructure have contributed to a lack of relevant samples for clinical care and research. There is a need for a Europe-wide framework to be implemented for the adequate and minimal sampling, processing, storage, and analysis of patient samples. Two international panels of scientists, clinicians, and patient and parent advocates have formed the Fight Osteosarcoma Through European Research consortium and the Euro Ewing Consortium. The consortia shared their expertise and institutional practices to formulate new guidelines. We report new reference standards for adequate and minimally required sampling (time points, diagnostic samples, and liquid biopsy tubes), handling, and biobanking to enable advanced biological studies in bone sarcoma. We describe standards for analysis and annotation to drive collaboration and data harmonization with practical, legal, and ethical considerations. This position paper provides comprehensive guidelines that should become the new standards of care that will accelerate scientific progress, promote collaboration, and improve outcomes.

Anticancer Fund Meise Belgium

Balgrist University Hospital Faculty of Medicine University of Zurich Zurich Switzerland

Biomedical Research Centre Norwich Medical School University of East Anglia Norwich United Kingdom

Bone and Soft Tissue Sarcomas and Innovative Therapies Unit IRCCS Istituto Orthopedico Rizzoli Bologna Italy

Center for Pediatric Adolescent and Women's Medicine Klinikum Stuttgart Olgahospital Stuttgart Cancer Centre Stuttgart Germany

Center for Pediatric Oncology and Hematology Vilnius University Hospital Santaros Klinikos Vilnius Lithuania

Children's Cancer Research Center Klinikum Rechts der Isar Technical University of Munich Munich Germany

Children's Cancer Research Group Leeds Institute of Medical Research University of Leeds Leeds United Kingdom

Computational Biology and Systems Medicine Group Centre for Molecular Medicine Norway University of Oslo Oslo Norway

Department of Hematology and Oncology A Trousseau Hospital Sorbonne University APHP Paris France

Department of Medical Oncology Institut Bergonié Bordeaux France

Department of Medical Oncology Institut Curie Paris France

Department of Musculoskeletal Radiology Royal Orthopaedic Hospital NHS Foundation Trust Birmingham United Kingdom

Department of Oncology for Child and Adolescent Gustave Roussy Cancer Campus Université Paris Saclay Villejuif France

Department of Oncology Oslo University Hospital Oslo Norway

Department of Oncology University College London Hospitals NHS Foundation Trust UCL Cancer Institute London United Kingdom

Department of Orthopaedic Surgery and Traumatology Ghent University Hospital Belgium

Department of Orthopaedics and Trauma Medical University of Graz Graz Austria

Department of Pathology Institut Universitaire du Cancer de Toulouse Oncopole Toulouse France

Department of Pathology IRCCS Istituto Ortopedico Rizzoli Bologna Italy

Department of Pathology UCL Cancer Institute University College London London United Kingdom

Department of Pediatrics and AYA Oncology Centre Oscar Lambret Lille France

Department of Public Health and Pediatrics University of Turin Turin Italy

Division of Cancer Sciences School of Medical Sciences The University of Manchester Manchester United Kingdom

Division of Imaging and Oncology University Medical Center Utrecht Utrecht the Netherlands

EQ ONCOSARC CRCT Inserm UT3 ERL CNRS Toulouse France

Great North Children's Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom

Haematology Oncology Children's Health Ireland at Crumlin Dublin Ireland

Hematology Oncology and Stem Cell Transplantation HUS Helsinki University Hospital New Children's Hospital Helsinki Finland

Histopathology The Royal National Orthopaedic Hospital NHS Trust Stanmore United Kingdom

Institute of Hematology and Pediatric Oncology Léon Bérard Center Lyon France

Institute of Medical Genetics and Pathology University Hospital Basel Basel Switzerland

Laboratory of Experimental Oncology IRCCS Istituto Ortopedico Rizzoli Bologna Italy

Leiden Center for Computational Oncology Leiden University Medical Center Leiden the Netherlands

Medical Oncology Leiden University Medical Center Leiden the Netherlands

Medical Oncology Vall d'Hebron University Hospital Barcelona Spain

Musculoskeletal Radiology Klinikum Rechts der Isar Technical University of Munich Munich Germany

Oncology and Surgical Oncology for Children and Youth Institute of Mother and Child Warsaw Poland

Orthopaedic Oncology Leiden University Medical Centre Leiden the Netherlands

Orthopaedic Oncology The Royal National Orthopaedic Hospital NHS Trust Stanmore United Kingdom

Orthopaedics and Trauma IRCCS Istituto Ortopedico Rizzoli Bologna Italy

Paediatric Haematology and Oncology University Hospital Motol Prague Czech Republic

Paediatric Oncology Royal Manchester Children's Hospital Central Manchester University Hospital NHS Foundation Trust Manchester United Kingdom

Pathology Leiden University Medical Center Leiden the Netherlands

Patient and Parent Advocacy Group FOSTER Washington District of Columbia

Pediatric Hematology Oncology Ippokratio General Hospital of Thessaloniki Thessaloniki Greece

Pediatric Oncology Klinikum Kassel Kassel Germany

Pediatric Oncology Regina Margherita Children's Hospital Turin Italy

Pediatric Oncology Unit Karolinska University Hospital Stockholm Sweden

Pediatrics 3 West German Cancer Center University Hospital Essen German Cancer Consortium Cologne Essen University of Duisburg Essen Essen Germany

Pediatrics St Anna Children's Hospital Medical University Vienna Vienna Austria

Portuguese Institute of Oncology of Lisbon Lisbon Portugal

Princess Maxima Center for Pediatric Oncology Utrecht the Netherlands

School of Medicine Nantes Université Nantes France

St Anna Children's Cancer Research Institute Vienna Austria

The Christie NHS Foundation Trust Manchester United Kingdom

The Danish Centre for Particle Therapy Aarhus University Hospital Aarhus Denmark

The George Pantziarka TP53 Trust London United Kingdom

Tumour Orthopaedics University Hospital Essen German Cancer Consortium Cologne Essen University of Duisburg Essen Essen Germany

U1015 Université Paris Saclay Villejuif France

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