What's new in musculoskeletal tumor surgery.

Abstract

The field of musculoskeletal oncology is broad and includes the study and treatment of a rare group of connective-tissue tumors. Although these tumors are uncommon, they can have devastating consequences for the life and the limb of the patient. In this field, which involves not only orthopaedics but other subspecialties as well, there is a rapid explosion of new information each year from a variety of fronts. I will try to summarize the important findings as reported both in the literature and at tumor meetings in 1999 and 2000. I will focus primarily on malignant neoplasms of bone and soft tissue. One area of interest to orthopaedic oncologists is the stratification of patients into specific prognostic groups, not only to predict outcome but also to identify the patients with poor prognoses who might benefit from innovative treatment strategies. For most tumors there are known clinical factors that indicate a good or poor prognostic category. ### Ewing Sarcoma/ Primitive Neuroectodermal Tumor Ewing sarcoma/primitive neuroectodermal tumor is a family of primitive round-cell tumors with a common karyotypic translocation between chromosomes 11 and 22. In the past they were nearly uniformly fatal neoplasms, but major advances in treatment have been made, primarily as a result of the use of adjuvant chemotherapy and proper local control. Prognostic factors in 975 patients with Ewing sarcoma were reported in a paper from the European Intergroup Cooperative Ewing’s Sarcoma Study Group (EICESS), which is a cooperative effort of the Medical Research Council/United Kingdom Children’s Cancer Study Group and the Cooperative Ewing Sarcoma Study1. The study included patients treated between 1977 and 1993 with similar chemotherapy protocols. The strengths of this retrospective analysis are the large number of patients and the substantial follow-up period (a median of 6.6 years). The most important adverse prognostic factor was metastatic disease detectable at the time …