An Abbreviated History of Orthopaedic Oncology in North America

Orthopaedic oncology in North America has its roots in European medicine of the 1800s where sarcomas were first classified on the basis of their gross characteristics (1804) and amended on the basis of their histologic features (1867). Surgical treatment, local excision, with unacceptable mortality led to amputation in the 1870s and remained so until limb-sparing resection was cautiously embarked on in the mid-1900s. Nonsurgical adjuvant therapy 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 techniques in the past 30 years, and the vastly improved staging and reconstructive techniques has led to the current preponderance of limb-salvaging surgery and greatly improved survival rates. The application of these treatments has been enhanced by the development of orthopaedic oncology fellowships, orthopaedic oncology societies, and federally funded regional cancer centers and multidisciplinary teams to treat patients with sarcomas.