History of Orthopedic Oncology in the United States

Progress from the Past, Prospects for the Future
Part of the Cancer Treatment and Research book series (CTAR, volume 152)


Orthopedic oncology in the United States has its roots in European medicine of the 1800s in which sarcomas were first classified on the basis of their gross characteristics (1804) and amended on the basis of their histologic features (1867). Surgical management, local excision, with unacceptable mortality gave way to amputation in the 1870s and remained so, until limb-sparing resection was cautiously embarked upon in the mid 1900s. Nonsurgical adjuvant was first devised in the 1880s (as Coley’s toxins) but remained largely ineffective until the advent of chemotherapy in the 1970s. The combination of these in the last 30 years, together with vastly improved staging and reconstructive techniques has led to the current preponderance of limb-salvaging surgery and greatly improved survival rates. Their application has been greatly enhanced by the development of Orthopedic oncology fellowships, formation of Orthopedic oncology societies, and the institution of federally funded regional cancer centers with the formation of multidisciplinary sarcoma treatment teams.


Bone Tumor Limb Salvage Giant Cell Tumor Orthopedic Oncology Musculoskeletal Tumor Society 


  1. 1.
    Abernathy J. Surgical Observations on Tumors. London: Longman and Rees; 1804.Google Scholar
  2. 2.
    Cooper A, Travers B. Surgical Essays, Part I. 3rd ed. London: Cox and Son; 1818:169-223.Google Scholar
  3. 3.
    Boyer A. The Lectures of Boyer Upon Disease of the Bone. Philadelphia: James Humphreys; 1805:182-186.Google Scholar
  4. 4.
    Dupuytren G. On Injuries and Diseases of Bones [Le Gros Clark F, Trans.]. London: Sydenham Society; 1847:418.Google Scholar
  5. 5.
    Recamier JC. Recherches sur le Traitment du Cancere par la Compression Methodique. Paris: Gabon; 1829.Google Scholar
  6. 6.
    Cruveilhier J. Anatomie Pathologique Kdu Corps Humaine. Paris: JB Baillier; 1829.Google Scholar
  7. 7.
    Lebert H. Physiologie Pathologiques des Recherches Cliniques, on Experimentales et Microscopiques, etc. Paris: JB Bailliere; 1845.Google Scholar
  8. 8.
    Virchow R. Die Krankenhaften Gewulstewulste. Berlin: Hirschwald; 1867:170-384.Google Scholar
  9. 9.
    Gross SW. Sarcoma of the long bones: Based on a study of one hundred sixty-five cases. Am J Med Sci. 1879;8:338-377.CrossRefGoogle Scholar
  10. 10.
    Coley W. The Treatment of Malignant inoperable Tumors with the Mixed Toxins of Erysipelas and Bacillus Prodigiosus. Brussels: W Eisenbruch; 1914.Google Scholar
  11. 11.
    Codman EA. The Use of the X-ray and Radiation in Surgery. In: Keen WB, ed. Surgery, Its Principles and Practice by Various Authors. Philadelphia: WB Saunders; 1909:1170.Google Scholar
  12. 12.
    Codman EA. The Shoulder. Thomas Todd Co, Printers: Boston; 1934.Google Scholar
  13. 13.
    Ewing J. Neoplastic Diseases. Philadelphia: WB Saunders Co; 1919.Google Scholar
  14. 14.
    Ewing J. An analysis of radiation therapy in cancer. Trans Coll Phys Philadelphia. 1922;44:190-235.Google Scholar
  15. 15.
    Ferguson AB. Treatment of osteogenic sarcoma. J Bone Joint Surg. 1940;22:92-96.Google Scholar
  16. 16.
    Coly BL, Harrold CC Jr. An analysis of fifty-five cases of osteogenic sarcoma with survival for five years or more. J Bone Joint Surg. 1950;32A:307-310.Google Scholar
  17. 17.
    Coventry MB, Dahlin DC. Osteogenic sarcoma: A critical analysis of 430 cases. J Bone Joint Surg. 1957;39A:741-757.Google Scholar
  18. 18.
    Geshickter CE, Copeland MM. Tumors of Bone. Am J Cancer New York City, 1931.Google Scholar
  19. 19.
    Jaffe HL. Tumors and Tumorous Conditions of the Bone and Joints. Philadelphia: Lea & Febiger; 1958.Google Scholar
  20. 20.
    Phemister DB. Conservative surgery in the treatment of bone tumors. Surg Gynecol Obstet. 1940;70:355-364.Google Scholar
  21. 21.
    Krause F. Uber die Behandlund der Schaligen Myelogenen Sarkome (Myeloide, Riesen-zellenmark-sarkome Durch k Aus Raumung Anstart Durch Amputation. Verb Dtsch Ges Chir. 1889;18:198-202.Google Scholar
  22. 22.
    Hinds F. Case of myeloid sarcoma of the femur treated by scraping. Br Med J. 1898;1:555.CrossRefGoogle Scholar
  23. 23.
    Bloodgood J. The conservative treatment of giant cell sarcoma with the study of bone transplantation. Ann Surg. 1912;56:210-239.CrossRefPubMedGoogle Scholar
  24. 24.
    Goldenberg RR, Campbell CP, Bonfiglio M. Giant cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg. 1970;52A:619-664.Google Scholar
  25. 25.
    Marcove RC, Wers LD, Vagharwalla MR, et al. Cryosurgery in the treatment of giant cell tumors of bone: A report of 52 consecutive cases. Clin Orthop. 1978;34:275-289.Google Scholar
  26. 26.
    Person BM, Wouters HW. Curettage and acrylic cementation in surgery of giant cell tumors of bone. Clin Orthop. 1976;120:125-133.Google Scholar
  27. 27.
    Morris H. Conservative surgery. Lancet. 1876;1:440.Google Scholar
  28. 28.
    Mikulicz J. Ueber Ausgedehnte Resectionen der langen Rohrenknochen Weten Maligner Geschwulste. Arch Klin Chir. 1895;50:60-75.Google Scholar
  29. 29.
    Lexer E. Die Vervendung der freien Knochenplastikk nebst Versuchen udber Glenk-versteifung und Gelenktransplantation. Arch Klin Chir. 1908;86:939-954.Google Scholar
  30. 30.
    Linberg BE. Interscapulo-thoracic resection for malignant tumors of the shoulder joint region. J Bone Joint Surg. 1928;10:344-349.Google Scholar
  31. 31.
    Sauerbruch F. Die Extripatipn des Femur mit Umkipp-Plastik des Unterschenkels. Dtsch Zeit Chir. 1922;169:1-12.Google Scholar
  32. 32.
    Juvara E. Reconstitution de la tige osseuse femorotibbiale. Bull Mem Soc Nat Chir. 1929;55:541-556.Google Scholar
  33. 33.
    Cortes EP, Holland JF, Wang JJ, et al. Amputation and adriamycin in primary osteo-sarcoma. N Engl J Med. 1974;291:998-1000.CrossRefPubMedGoogle Scholar
  34. 34.
    Enneking WF. Limb Salvage in Musculoskeletal Oncology. Churchill Livingstone: New York; 1987.Google Scholar
  35. 35.
    Volkov V. Allotransplantation of joints. J Bone Joint Surg. 1970;52B:49-53.Google Scholar
  36. 36.
    Ottolenghi CE. Massive osteo and osteo-articular bone grafts: Technic and results in 62 cases. Clin Orthop. 1972;87:156-164.CrossRefPubMedGoogle Scholar
  37. 37.
    Parish FF. Treatment of bone tumors by total excision and replacement with massive autologous and homologous grafts. J Bone Joint Surg. 1968;48A:968-990.Google Scholar
  38. 38.
    Czitrom AA, Keating S, Gross AE. The viability of articular cartilage in fresh osteo-chondondral grafts after clinical transplantation. J Bone Joint Surg. 1990;72A:574-581.Google Scholar
  39. 39.
    Mankin HJ, Fogelson FJ, Thrasher DZ, et al. Massive resection and allograft transplantation in the treatment of malignant bone tumors. N Engl J Med. 1976;294:247-255.CrossRefGoogle Scholar
  40. 40.
    Wilson PD Jr. A clinical study of the biomechanical behaviour of massive bone transplants used to reconstruct large bone defects. Clin Orthop. 1972;87:81-109.PubMedGoogle Scholar
  41. 41.
    von Eiselsberg A. Zur heilungkgrosser defecte der tibia durch gestielte haut-periost-knochenlappen. Arch Klin Chir. 1887;55:435-444.Google Scholar
  42. 42.
    Phelps AM. Transplantation of tissue from lower animals to man. Med Rec. 1881;39:221-225.Google Scholar
  43. 43.
    Carrel A. Results of transplantation of blood vessels, organs and limbs. J Am Med Assoc. 1908;51:162-167.Google Scholar
  44. 44.
    Peltier LF. Patron saints of medicine. Clin Orthop. 1997;334:374-379.PubMedGoogle Scholar
  45. 45.
    Bert P. Greffe Animale Parapproache [De Deux Jeunes Rats Albinos Dequinze Jours]. Paris: Impr Coson; 1862.Google Scholar
  46. 46.
    Burchardt H, Glowczewskie FP, Enneking WF. Short-term immuno-supression with fresh segmental fibular allografts in dogs. J Bone Joint Surg. 1981;63A:411-415.Google Scholar
  47. 47.
    Moore AT, Bohlman HR. Metal hip joint: A case report. J Bone Joint Surg. 1943;25:88-92.Google Scholar
  48. 48.
    Scales JT, Waite ME, Wright KW. Intramedullary fixation of “custom made” major endoprostheses with special reference to the bone response. Eng Med. 1984;13:185-189.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Departments of Orthopaedics and Pathology, College of MedicineUniversity of FloridaGainesvilleUSA

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