[Malignant bone tumors--is amputation still necessary today?].

Only one half percent of all malignant tumors are solid primary bone tumors. Early diagnosis, however, is essential, as even in the most malignant tumors (osteosarcoma and Ewing sarcoma, primarily found in adolescents) prognosis after adequate treatment is quite good. A bone tumor should be considered, when pain at an extremity is unilateral and not clearly dependent on activity, especially when it is present at night. In such cases an X-ray should be made. The diagnosis of a malignant bone tumor is always assured by biopsy. Treatment in osteosarcoma and Ewing sarcoma starts with high-dose chemotherapy over three months. After this time, a wide resection of the tumor has to be carried out. The diagnostic tools available today allow a very precise knowledge of the extent of the tumor. An amputation is, therefore, only very rarely indicated. Histologic examination of the resected tumor shows the reaction of the tumor to chemotherapy. In a good responder more than 90% of the tumor is necrotic; therefore, the chemotherapeutic treatment is continued unchanged during another nine months. In case of poor response the drug treatment is modified. Treatment follows an internationally controlled protocol. With this procedure we can expect a survival rate of 70% in osteosarcoma. Ewing sarcomas metastasize very early, but a survival rate of 50% still is realistic. Chondrosarcomas occur in an older age group. They are less malignant. Their treatment is purely surgical. For an adequate resection of chondrosarcomas and a multitude of other low-grade tumors a lot of experience is needed.(ABSTRACT TRUNCATED AT 250 WORDS)