Showing papers by "William F. Enneking published in 1988"

Surgical treatment for osteosarcoma.

Abstract: Fifty-three patients who had a high-grade osteosarcoma had either a limb-salvage resection or an amputation. They all received adjuvant therapy that consisted of administration of Adriamycin (doxorubicin) and whole-lung irradiation. At the time of follow-up, the surgical margin was assessed by examination of the surgical specimen. Each patient was followed for at least three years or until death. The data suggested that a wide surgical margin is adequate to control a primary osteosarcoma. When a wide surgical margin can be used and a functional limb can be salvaged, an amputation probably is not required.

High-risk Ewing's sarcoma: end-intensification using autologous bone marrow transplantation.

Abstract: Because of a retrospective analysis showing survival to be related to primary tumor size, in February 1982 a study to test this hypothesis prospectively was begun at the University of Florida. Patients with primary tumors 8 cm or less in maximum diameter and no metastases received adjuvant chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, and dactinomycin plus radiotherapy or surgery (standard-risk protocol). All others received a similar regimen followed by end-intensification with high-dose melphalan and autologous bone marrow transplantation (Protocol HR-2). Because of poor results of HR-2, another high-risk protocol (HR-3) was initiated in January 1985. Patients on HR-3 received 2 cycles of chemotherapy containing vincristine, cyclophosphamide, and doxorubicin followed by local radiation therapy and maintenance chemotherapy. At the end of this therapy, autologous bone marrow transplantation (ABMT) was performed, using a preparatory regimen of total body irradiation and intensive chemotherapy. The 2-year disease-free survival rate was 70% for the standard-risk protocol, 20% for HR-2, and 80% for HR-3. The follow-up on HR-3 is still short, but the results are promising enough to warrant further clinical trials.

A system of staging musculoskeletal neoplasms.

Abstract: A system for staging benign and malignant musculoskeletal lesions is presented. This system, first devised at the University of Florida in 1977, was based on data assembled from 1968 through 1976. It was field tested by the Musculoskeletal Tumor Society and published in Clinical Orthopaedics and Related Research in 1980. In the ensuing five years, the system has undergone refinement. It has recently been adapted by the American Joint Committee Task Force on Bone Tumors and proposed by them to the International Union Against Cancer (IUCC) for international usage. Based upon histologic grade (G), anatomic site (T), and presence or absence of metastases (M), it describes the progressive stages, irrespective of histogenesis, that assess the progressive degrees of risk to which the patient is subject. This system articulates well with current radiologic techniques of staging and serves as a useful guide in the selection of an appropriate definitive surgical procedure. Its usage permits comparative end result studies on the effect of surgical and nonsurgical methods of management.

The effect of inadvertent tumor contamination of wounds during the surgical resection of musculoskeletal neoplasms.

Abstract: The effect of inadvertent tumor violation with visually evident wound contamination during the surgical resection of musculoskeletal neoplasms is unknown. In an attempt to assess the significance of wound contamination by tumor tissue, the incidence of local recurrence in 28 cases of known wound contamination was determined. The influence of immediate lavage, re-excision, subsequent surgical margin, and the use of adjuvant chemotherapy and/or radiation therapy upon local recurrence was assessed. Achieving a wide surgical margin by immediate re-excision after contamination gave a significantly lower incidence of recurrence than those with lesser final margins (P less than 0.01). The use of postoperative adjuvant chemotherapy or irradiation resulted in a lower recurrence rate, but the difference between those with and without adjuvant treatment had statistically less significance than the surgical margin on the incidence of local recurrence (P less than 0.2). The risk of local recurrence after contamination was not influenced by the histologic grade of the tumor.

Musculoskeletal Tumor Staging — 1987 Update

Abstract: Since 1960, prospective primary observational data has been gathered and stored on primary benign and malignant neoplasms of the musculoskeletal system in the W. Thaxton Springfield Study Center at the University of Florida. In 1974, based upon analysis of this data, a staging system for primary malignant tumors of connective tissue histogenesis was constructed together with definitions of oncologic surgical margins and oncologic surgical procedures. By 1979, 258 cases had been staged and enough time had passed to evaluate the system. At that time, the Musculoskeletal Tumor Society (MTS) contributed an additional 139 cases from thirteen member institutions to form an initial study group of 397 cases.