The author's experience in the diagnosis and treatment of primary malignant bone tumors (700 cases) is reviewed, together with the experience of the staff a t T h e University of Texas M. D. Anderson Hospital and Tumor Institute, to evaluate various approaches to diagnosis and treatment, and to determine whether progress has been made in treating bone sarcoma. The survival rates remain fairly constant and continue to be largely influenced by the adequacy of the surgery performed. Radiation therapy, while largely palliative, plays a role in adjunctive and definitive treatment (especially in reticulum cell sarcoma of bone). High energy forms of radiation therapy prove superior to orthovoltage treatment. The clinical achievements of chemotherapy present scant evidence that it plays more than a n adjunctive palliative role in the majority of cases treated. There is evidence that in some cases it may play a n adjunctive role in successful treatment when used with radiation and/or surgery.
RIMARY MALIGNANT TUMORS OF BONE, AL-P though relatively rare, present a serious problem because of the difficulty in diagnosis and the generally poor prognosis for the patient. At T h e University of Texas M. D. Anderson Hospital a recent statistical review indicates that the incidence of bone sarcoma was 0.68oj, of all malignant lesions seen between 1941 and 1961. During the last 35 years more than 700 cases of primary malignant tumors of bone have been either personally diagnosed and treated or reviewed and followed with Dr. C. F. Geschickter in Dr. Joseph Colt Bloodgood's Pathological Laboratory at the Johns Hopkins University Medical School and, later at the Georgetown University School of Medicine.
The results of treatment in this group of patients will be reviewed in summary, with emphasis on the more recent experience of the M. D. Anderson staff and others, to evaluate newer approaches to treatment in bone sarcoma and to determine whether we have made any real advances over the standard concepts of early diagnosis, amputation, radical resection and/or irradiation. Some of the newer variations in treatment include: irradiation alone, with and without chemotherapy (perfusion or infusion); chemo-