Tumors Of Long Bones Research Articles

The metastatic patterns of osteosarcoma

The paper presents a detailed comparison of the anatomical distribution and frequency of clinically evident metastases in 152 cases of osteosarcoma, and autopsy findings in 43 cases. The behaviour of long bone tumours is contrasted with those arising elsewhere, which tend to metastasize less widely because of early death from effects of the primary tumour. In both clinical and autopsy series long bone tumours produced lung metastases (LM) in over 90% of patients dying with metastases, but the terminal frequency of extra-pulmonary metastases (EPM) rises from a clinical level of 33% to 83% at autopsy. There was little difference between tumours of the major long bones in the frequency of either LM or EPM, but EPM from the humerus tended to be fewer and sited above the diaphragm and from the femur below it. EPM most often involved other bones, notably vertebrae and pelvis. Not more than 10% of tumours invaded regional lymph nodes but terminally a quarter of the long bone tumours had metastasized to heart and abdomen. The infrequency of metastases in muscle was confirmed. The median time for LM was 5-6 months after starting treatment, for EPM 9-10. months. First metastases after 24 months were infrequent, especially in children. With delay in the appearance of metastases, whether LM or EPM, post-metastatic survival lengthened. Neither age, sex nor mode of treatment of the primary notably affected metastatic frequency, although recurrences were much more numerous when radiotherapy, even with high dosage, was the definitive treatment. Local recurrence usually appeared within 6-8 months and was shown to lead to increased frequency of osseous metastases. It is suggested that terminal dissemination may often be tertiary but not always from a pulmonary secondary.

Metastatic spread of osteosarcoma.

A study is presented of the rate of metastatic spread of osteosarcoma. The series consists of 123 tumours in long bones and 26 elsewhere in the skeleton. All tumours occurred in otherwise normal bones and were histologically proven. With a few stated exceptions all the cases were consecutively registered.Both the mean disease-free interval from the time of starting treatment and the crude survival curves are given. The long bone cases are analysed by groups according to the method of treatment, the patient's sex, age and tumour site. There were too few tumours of all other sites to warrant this discriminative treatment. Whilst the results of surgical treatment are better than for radiotherapy or a combined technique, the differences are not statistically significant and the information is recorded primarily to assist the evaluation of new forms of treatment of occult and overt metastases. Some problems in connection with such clinical trials are discussed briefly.

Ewingʼs Sarcoma of the Hand

The purpose of this paper is to document two unusual cases of Ewing's sarcoma of the hand. The clinical picture was one that did not include fever, leukocytosis, increased sedimentation rate, or cortical sclerosis. The roentgen appearance was [See figure in the PDF file] distinctly different from that of classic Ewing's tumor in the larger long bones. Both patients were treated by adequate resection of the tumor and are tumor-free two and three years, respectively, after surgery.