HISTORY OF MUSCULOSKELETAL TUMOR

EARLIEST IDENTIFICATION OF BONE TUMORS

Until the mid 19th century, tumorous processes in the bones and speculation of cellular origin of the
tumor were not recognized, as the microscopes which determine the evaluation of tumor were not
commonly used for pathological purposes until the mid 19th century, and furthermore, the X-ray was
introduced in 1895.
In 1981, surgeons and pathologists finally started collaborating in diagnosing malignant disease on a
rapidly performed frozen section.

MANAGEMENT OF BONE AND SOFT TISSUE TUMORS

The biggest changes to the management of the tumor happened in the last 30 years. These changes
took place due to the use of chemotherapeutic agents, radiation oncologic treatments, and improved
imaging technology(identification).

 Radiotherapy
In 1900, Kienbock reported the effect of radiation to the rats which he used in his experiment. Then, it
was agreed that radiation could be useful to management of patients.
In 1933, Emil Grubbe(Chicago) reported the successful treatment case of a breast cancer patient using
radiation. He also reported the occurrence of dermatitis in his own hands, and so, he was the first to
use a lead shield in order to reduce the radiation damaging unaffected parts of the body.

 Chemotherapy
In 1973, Norman Jaffe and coworkers introduced high-dose methotrexate with leucovorin rescue
for the treatment of osteosarcoma.
At almost the same time, the effect of adriamycin or doxorubicin on osteosarcoma was reported, that
it could bring the survival rate to greater than 40%.

In the 1970’s, Rosen introduced the concept of neoadjuvant therapy, which allowed the treating
physicians to assess the effect of the drugs chosen on the target tumor, before performing resective
surgery, and so, allowed possible changes in protocol.

These drugs, and the neoadjuvant approach highly increased the long-term survival rate of all high
grade tumors to 70% ~ 80%.

ORTHOPAEDIC MANAGEMENT OF PATIENTS WITH SARCOMAS

Until the 1940’s, tumor management was quite difficult and for high grade tumor patients usually had
amputations performed or received radiation therapy. Reconstructive surgery and limb-sparing
surgery was not performed often.

Clearly, amputation was the option for malignant bone or soft tissue tumors unless the lesions were
small or easily accessible.

Recently(in 21st century), with the neoadjuvant & adjuvant radiation/chemotherapy (+ improved
surgical technology), orthopedists developed a series of systems for surgical eradication of the
lesions.
Which in many cases now, are successful in keeping a functional limb and have greatly decreased the
disability of the affected patients.

There are several reasons behind these advances:

 Growth in knowledge of lesions made the behavior more predictable
 Improved imaging technology (CT, MRI)
 Clearer assessment of the biopsy technology
 Use of adjuvant and neoadjuvant therapy
 Ability to treat lung metastasis effectively have made great advances

SUMMARY AND DISCUSSION

In the past, every high grade sarcoma patients died or was amputated surgically. However, as the
knowledge and medical technologies improve, medical oncologists and radiation oncologists
providing drugs in adjuvant and neoadjuvant protocols have greatly improved the patient’s survival
rate.

This is the result of information gained from staging studies. It allowed the development of protocols
for the resection of bone and soft tissue tumors which are safe and cause the least damage nowadays.