Limb Salvage in Musculoskeletal Oncology [antikvár]

INTRODUCTION In 1981 the first International Symposium dealing with limb salvage techniques in musculoskeletal oncology was held in Rochester, Minnesota. The stimulus for that symposium, organized by staff members of the Mayo Clinic and chaired by Drs. Edmund Y. S. Chao and J. Ivins, was the need for prosthetic replacements to reconstruct limbs salvaged by local resection of aggressive and malignant bone and soft tissue sarcomas. The symposium was of necessity a broadly based discussion of the then state of the art. During the second half of the 1970s, there was a burst of enthusiasm for limb-saving resection under the putative umbrella of adjuvant chemotherapy and/or irradiation therapy, and when the symposium was held it was time to take stock of the advantages and limitations of this rapidly expanding and appealing technique. From the many presentations it was estimated that the local recurrence rates among the 522 cases that formed the clinical basis for the presentations was 18% and that the complications of the reconstructive techniques had led to subsequent amputation in 15% of the cases. Thus, the overall salvage rate was approximately two-thirds of the attempts made. In the publication of the proceedings, Ivins noted that two major obstacles to progress in the field were the lack of a staging system for musculoskeletal tumors, which made evaluation of surgical oncologic techniques difiBcult, and the lack of a standardized system for evaluating the clinical results of the reconstructive techniques and materials. whether biologic or prosthetic. During that symposium the surgical staging system adopted in 1980 by the Musculoskeletal Tumor Society was presented and was adopted for use in the next symposium planned for 1983. The second symposium was held in September 1983 in Vienna under the chairmanship of Professor R. Kotz. The symposium was devoted primarily to discussions of reconstructive techniques. From the oncologic viewpoint, the recurrence rate among the 603 cases presented was 11%. Estimates of the recurrence rates by surgical margins were 12 of 39 (30%) for marginal resections and 47 of 564 (8%) for wide resections. The effects of adjuvant chemotherapy on recurrence rates were also estimated as 15 of 213 (7%) for preoperative chemotherapy, 11 of 143 (8%) for postoperative chemotherapy, and 33 of 287 (12%) when chemotherapy was not used. During the 1983 symposium, a system for the functional evaluation of various reconstructive techniques was presented, discussed, and adopted for trial at the next symposium. From the many presentations at the symposium several problem areas were identified. It was the consensus of the organizers that the 1985 symposium should have as its main thrusts a sharp focus on several issues and a broadly based trial of the functional evaluation system. The issues selected for focus were (1) the technology of prosthetic fixation, (2) the techniques of reconstruction after pelvic resec-