Diagnostic procedures and surgical treatment of bone sarcomas. Experience from the Scandinavian Sarcoma Group and Karolinska Hospital.

In 1979, the year when Scandinavian Sarcoma Group (SSG) was created, treatment of patients with osteosarcoma and Ewingʼs sarcoma was most often amputation. The diagnostic and preoperative tools were plain radiographs and sometimes CT and/or angiography. Histopathologic diagnosis was achieved by open biopsy. In the few cases treated by a local excision, reconstruction was performed with allografts or joint prostheses. The local recurrence rate after local excision of osteosarcoma was sometimes as high as 30% (Bauer et al. 1989). Despite these surgical efforts, most patients died in metastatic disease. At this time, Dr. Gerald Rosen had started adjuvant multidrug chemotherapy of patients with osteosarcoma or Ewingʼs sarcoma (Rosen at al. 1975, Rosen et al. 1981). At the Karolinska Hospital, Dr. Hans Strander used human leucocyte interferon, instead of chemotherapy, as an adjuvant treatment after surgery in patients with osteosarcoma (Strander 1977). In this presentation, we will focus on the progress, over the last 25 years, in the diagnostic procedures and surgical treatment of patients with osteosarcoma and Ewingʼs sarcoma in Scandinavia and our policy at the Karolinska Hospital.