[Clinical evaluation of limb-salvage procedures in malignant bone tumors--a study of 54 cases]

Recent advances in therapy such as local and systemic chemotherapy, wide resection, and aggressive thoracotomy improved the survival of the patients with malignant bone tumors. Since 1981, we have performed limb-salvage operations for 54 cases of malignant bone tumors of the extremities. In this study, we report the rate of local recurrence and the prognosis of the patients. We treated 37 osteosarcomas, 8 malignant fibrous histiocytomas of bone, 3 Ewing's sarcomas, 3 parosteal osteosarcomas, 2 chondrosarcomas, and one fibrosarcoma. The age of the patients ranged from 11 to 65 years (mean, 18.5). The male/female ratio was 2:1. The surgical stage was 47 at II B and 7 at III. The follow-up period was 14 to 84 months (mean 36). They received preoperative chemotherapy including intraarterial infusion of Adriamycin, and postoperative chemotherapy for ten months. Local recurrence was detected in 2/54 (3.7%). Lung metastases (Stage II B) developed in 9/47 (19.1%). Five of them (10.7%) died of metastasis, one is alive with metastases, and 41 cases are now disease-free. Six of seven cases (Stage III) died of metastasis, despite aggressive chemotherapy and thoracotomies.