Results of Irradiation in the Treatment of Operable Osteogenic Sarcoma of the Long Bones

UP to 1923, the results following surgical treatment of periosteal or subperiosteal sarcoma, now classified as osteogenic sarcoma, were bad, one reason for this being that the diagnosis was not often made until the disease had reached such an advanced stage that there remained little hope of saving the life of the patient by amputation or other form of treatment. In a review of the statistics of various European clinics, mostly in England and Germany, Butlin (1) found only one three-year recovery in 68 cases of periosteal sarcoma of the femur treated by hip joint or high amputation, and not a single recovery in sarcoma of the humerus. Little improvement in results was noticed until 1920. In 1922, Meyerding (2), of the Mayo Clinic, reported 15 five-year recoveries in a series of 100 cases of sarcoma of the long bones, exclusive of giant-cell tumors, treated by amputation. In many of these cases, amputation was followed by prophylactic treatment with Coley's toxins, and in a number, by irradiation of the chest. An improvement in results was noticed in the European clinics also. In May, 1923, at a Symposium on Bone Sarcoma by the Association of Surgeons of Great Britain and Ireland, held in London, Gask reported 57 cases of sarcoma of the long bones, exclusive of giant-cell tumors, that had been admitted to St. Thomas' Hospital during the period from 1901 to 1921. In 46 cases amputation was performed; 12 patients were alive three years later; 7 were well for more than five years, and one died of metastasis to the skull almost seven years after amputation. These are exceptionally good results, and yet, when Meyerding read his paper at the meeting of the American College of Surgeons in 1922, Besley, of Chicago, who took part in the discussion, stated that he had amputated the limb for sarcoma of various types in 20 cases at the Cook County Hospital, and that, as far as he had been able to learn, there had not been a single permanent recovery. He added: “I have performed my last amputation for sarcoma of the long bones.” Only a few years later one of the most distinguished professors of pathology in America told me that if he personally had ever had a sarcoma of a long bone he should have an immediate amputation performed regardless of the histologic type of the tumor. Here we have two widely divergent views regarding the best method of treating sarcoma of the long bones. In further proof of this I would cite Crile (3), whose recent study of 7,390 cases of malignancy (of which 160 were bone sarcoma) has led him to the following conclusion: “It is still uncertain whether a primary malignancy of bone should be treated by x-ray or by surgery, but two things are certain—first, if an operation is performed, it should be preceded and followed by x-ray radiation, and second, if the condition is in a limb, amputation should immediately follow radiation, provided the condition is not inoperable.”