En bloc resections for osteogenic sarcoma.

This paper presents a preliminary report of 66 patients who underwent en bloc resection for osteogenic sarcoma of the femur (34 patients), tibia (12 patients), shoulder girdle (19 patients), and fibula (1 patient). Presentation of a limb, without sacrificing the principles of cancer surgery, is a desirable goal in people with osteogenic sarcoma. Up to the present time, amputation has been regarded by most authorities as the only well-established typical curative treatment for this malignancy. Usually when a tumor is close to a joint, amputation includes excision of a part of the adjacent joint as well as a wide removal of the involved bone to encompass both area of potential capsular-joint local skip and possible intraosseous skip areas of tumor. The former has been observed more than the latter. In an effort to improve survival rates, the distal femur lesion (having the lowest extremity cure rate in our opinion) requires removal of the whole bone. The following study was undertaken to determine whether en bloc resection in association with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy. We believe our definition of osteogenic sarcoma, unlike some, excludes the good prognostic medullary invading juxtacortical osteogenics, chondrosarcomas (making bone), and includes telangiectatic osteogenic sarcomas. Therefore, our cure rate, with amputation under the age of 21 was 17% with no evidence of disease. Any paper not analyzing the age of the patient (under 21 years old) cannot in itself be comparable. Cure rates of older patients can be as high as 35% according to Dr. Andrew Huvos at our hospital.