History of orthopedic oncology in the United States: progress from the past, prospects for the future.

Orthopedic oncology in the United States has its roots in European medicine of the 1800s in which sarcomas were first classified on the basis of their gross characteristics (1804) and amended on the basis of their histologic features (1867). Surgical management, local excision, with unacceptable mortality gave way to amputation in the 1870s and remained so, until limb-sparing resection was cautiously embarked upon in the mid 1900s. Nonsurgical adjuvant was first devised in the 1880s (as Coley's toxins) but remained largely ineffective until the advent of chemotherapy in the 1970s. The combination of these in the last 30 years, together with vastly improved staging and reconstructive techniques has led to the current preponderance of limb-salvaging surgery and greatly improved survival rates. Their application has been greatly enhanced by the development of Orthopedic oncology fellowships, formation of Orthopedic oncology societies, and the institution of federally funded regional cancer centers with the formation of multidisciplinary sarcoma treatment teams.