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Incidence of bone sarcoma in SW England, 1946-74, in relation to age, sex, tumour site and histology.

A study is presented of all cases of primary sarcoma of bone registered during the period 1946 to 1974 for a specified population resident in south-western England. Ninety-six per cent of the 365 cases were histologically and radiologically verified and are separated into 8 categories of sarcoma. The number of tumours presenting during each hemi-decade did not markedly diverge from the 5-year mean for the period, nor was any significant change found in tumour incidence during the last 20 years of the survey. The age, sex and site distributions correspond with those reported elsewhere. Age-specific incidence rates are compared with those published for Sweden. For osteosarcoma and Ewing's tumour, both commoner in young people, the two series agree closely up to age 55 years, after which the Swedish incidence rates rise and are not exceeded when, for the present cases, Paget's osteosarcomas are included. Whilst Paget's disease may change the age incidence of some types of bone sarcoma, it is uncertain whether it increases the total number which occur. Differences in tumour incidence between males and females, whether for a specific type or for all bone sarcomas, are seldom statistically significant, but the patterns appear to be consistent.

Adolescent

Radiation-induced soft-tissue and bone sarcoma.

From the records of Memorial Hospital of the past 50 years, 47 cases with an established diagnosis of radiation-induced sarcoma were identified and divided into two groups: the first included 20 cases of soft-tissue sarcoma arising from irradiated tissues, and the second comprised 27 cases of bone sarcoma arising from normal bones in the irradiated field. Medians for the latent periods from irradiation to diagnosis of bone and soft-tissue sarcoma were 11 and 12, years, respectively. In bone sarcomas, the latent period was longer after larger radiation doses and children appeared to be more susceptible to cancer induction than adults. Criteria for establishing the diagnosis of radiation-induced sarcoma and the magnitude of the risk of bone sarcoma are discussed.

Adolescent

[Multipotent primary bone sarcoma].

The results of clinical and roentgen-morphological studies on 17 cases of multipotent primary sarcoma of the bone are presented. The difficulties of the tumor recognition are due to the fact that it occurs rarely, has no specific clinical-roentgenological picture and shows marked tissue polymorphism. Most frequent are differentiations of the type of osteogenic sarcoma, chondrosarcoma, reticulosarcoma with simultaneous combination with areas having the structure of Ewing's tumor, or extensive fields of undifferentiated primitive tumor cells. Further studies are necessary to decide whether or not this tumor is an independent form among other known skeletal neoplasias.

Adolescent

[Bone sarcomas].

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Adolescent

Radiation in bone sarcomas: a re-evaluation in the era of intensive systemic chemotherapy.

We have reviewed the literature and described experience in treating Ewing's sarcoma and osteosarcoma before and during the era of intensive systemic chemotherapy. Local control of Ewing's sarcoma may relate to increasing doses of radiation, especially when intensive chemotherapy is administered also. Problems of radiation enhancement by chemotherapy have caused us to reconsider time-dose and volume parameters in treating these patients. The role of radiation in osteogenic sarcoma is limited to patients with inoperable lesions and metastases.

Bone Neoplasms

[Experimental production of bone sarcomas in the rabbit by a single local injection of beryllium].

The local intra-osseous injection of double zinc beryllium silicate into the tibial or femoral epiphysis of a rabbit causes an osteogenic sarcoma in 70 p. 100 of cases. These experimental conditions make it possible to reveal early non specific radiological alterations, later on secondary alterations corresponding to the development of the sarcoma and finally to follow the spontaneous evolution of the tumor. Moreover, this experimental process of induction of an osteogenic sarcoma by means of a local intra-osseous injection is vastly better than an intra-venous injection which causes straight-away multiple visceral lesions.

Animals

Bone sarcomas: etiology and immunology.

The etiology of skeletal sarcomas is found in induced by viruses in man (as they are in exogenous agents (irradiation, oncornavirus) acting in a peculiar setting of host factors. Patients with skeletal sarcomas react immunologically to autologous and allogeneic sarcoma cells, but reactors can be found among the healthy persons with or without exposure to patients with sarcomas. Various modalities of immunotherapy are available to increase the patient's immune reactivities in general or to sarcoma cells in particular, but immunotherapy of skeletal sarcomas has not yet brought about clear-cut and substantial benefits in addition to or beyond the results of conventional treatment.

Adolescent

[Bone sarcoma (author's transl)].

Sarcogenesis essentially follows two laws: The frequency of sarcoma is distributed according to the mesenchymal cell content in the different sections of the body. The sites of predilection are found within the same tissue systems in zones of increased growth activity and cell division. Clinical oncogenic statistics show that other factors apart from quantity of sarcogenic noxae and latent period are important in producing the malignancy. The synopsis of histology, X-ray findings and clinical examination is significant for diagnosis and for prognosis the degree of spread (TNM classification), localization and therapy. Early operation is still the most successful and most decisive therapeutic measure. The necessity for a supervised cancer follow-up is also shown in these tumors.

Adolescent

Radiation-induced sarcomas of bone.

Historically, the literature reveals that the incidence of radiation induced bone sarcomas is very low. Details related to epidemiology cannot be identified, however, because of the difficulty of identifying precisely the patient population at risk for development of the radiation induced sarcoma. The change in character of practice in cancer management with ever increasing numbers of patients receiving both radiation therapy and chemotherapy should alert physicians to the potential for increased incidence of this rare and unusual tumor.

Animals

Bone scanning in management of metastatic osteogenic sarcoma.

Bone scan findings are presented from five consecutive cases of metastatic osteogenic sarcoma. Every patient had pulmonary metastases which concentrated the bone imaging radiopharmaceutical to some degree. In one patient, the diagnosis of pulmonary metastasis was made prior to our seeing any radiographic abnormalities. The mechanism by which skeletal imaging agents localize in pulmonary lesions is not clear. Unsuspected skeletal metastases were also discovered on scans in two patients, both of whom had normal radiographs. Diagnosis of hypertrophic pulmonary osteoarthropathy was made in one patient with normal radiographs. These findings indicate that bone scans as well as radiographs should be performed routinely in preoperative staging and followup of patients with osteogenic sarcoma.

Adolescent

Postirradiation sarcoma of bone: a perspective.

Ten cases of irradiation induced sarcoma of bone which fulfilled Cahan's criteria were seen in a twenty year period at the Princess Margaret Hospital. The overall incidence of this complication is 0.035% of all irradiated five year survivors. Combining our data with three other large series presented in the literature, a dose complication curve could be deduced. On the basis of the human and animal data reviewed, it was concluded that the risk of radiation induced sarcoma is so low in the dose range of modern radiotherapeutic practise that it does not represent a contraindication to the use of radiation therapy.

Adult

Thorotrast-associated sarcoma of bone: A case report and review of the literature.

An osteosarcoma developed near the right lesser trochanter of a 55-year-old woman. The neoplasm fulfilled the generally accepted criteria for a Thorotrast related malignancy. Strengthening this relationship was the occurrence of the tumor in an unusual location and uncommon age group. Thorium was confirmed both in the tumor and in bone marrow histiocytes by its characteristic x-ray spectrum. Including this case only twelve Thorotrast-associated neoplasms of bone have been reported. The mean latency period after Thorotrast administration was 26 years. Regression analysis revealed that latency period and Thorotrast dose are inversely related. All tumors were reported to be sarcomas. Six osteosarcomas, one fibrosarcoma, one chondrosarcoma, and one undifferentiated sarcoma were proven histologically. All patients, for whom follow-up was given, had died of the tumor. The reasons behind the low frequency of reported Thorotrast-associated bone malignancies may be the low concentration of 232Th and radioactive daughters in bone, long latency period or the general lack of knowledge concerning the possible relationship between Thorotrast and bone tumors. Statistical association between Thorotrast injection and bone sarcoma is shown. The criteria for the diagnosis of Thorotrastosis are discussed as well as the long term deleterious effects. The distribution of Thorotrast within the body is discussed as well as the associated radiographic changes.

Adult

Kaposi's sarcoma in bone: a case report with unusual radiographic findings and an abnormal radioisotope scan.

The authors present a case report of Kaposi's sarcoma involving the bones of the forearm, wrist, and hand. Typical features of rarefaction, osteoporosis, cysts, and cortical erosions were present. Rarely seen changes of a bubbly expansion of the lesions and periosteal reaction were also present. This is the first radioisotope bone scan reported in Kaposi's sarcoma to the author's knowledge. The literature about osseous manifestations of Kaposi's sarcoma is reviewed.

Biopsy

Radium-induced malignant tumors of the mastoid and paranasal sinuses.

In the records of 5,058 persons with therapeutic or occupational exposure to radium, 21 patients with carcinoma of the mastoid and 11 with malignant tumors of the paranasal sinuses were identified. Tumor induction times were 21-50 years for mastoid tumors (median, 33) and 19-52 years for paranasal sinus tumors (median, 34). Dosimetric data are given for the patients whose body burdens of radium have been measured. We found a high proportion of mucoepidermoid carcinoma, comprising 38% of the mastoid and 36% of the paranasal sinus tumors. Three patients had antecedent bone sarcoma at 20, 11, and 5 years, respectively, and a bone sarcoma was discovered at autopsy in a fourth patient. Radiographic changes in the mastoid and paranasal sinuses were similar to those seen in nonradium malignant tumors. More than 800 known persons exposed to radium before 1930 and another group of unknown size who received radium water or injections of radium from physicians are still alive and at risk of developing malignant tumors of the mastoid and paranasal sinuses.

Adenocarcinoma