Table 42-4 Treatments for Musculoskeletal Tumors

Tumor Osteoid osteoma Osteoblastoma Osteosarcoma Secondary osteosarcoma Parosteal osteosarcoma Osteochondroma Enchondroma Parosteal chondroma Chondroblastoma Chondromyxoid fibroma Chondrosarcoma Fibroma Fibrosarcoma Ewing's sarcoma Unicameral cyst Aneurysmal cyst Giant cell tumor

Chemotherapy No No Neoadjuvant and postoperative If patient can tolerate No No No No No No No No Adjuvant systemic may improve survival Yes Steroid injection No No

Radiation No No No Palliative only No No No No No No

Surgery Excision Curettage or resection and bone graft Wide to radical resection with limb salvage or amputation Radical resection or amputation Wide surgical resection and reconstruction or wide amputation Simple excision; all cartilage cap must be removed Curettage and bone graft Marginal to wide resection and bone grafting Curettage and bone graft Aggressive curettage or marginal to wide excision and grafting

May be useful as adjuvant Wide or radical surgical resection for high-grade lesions and reconstruction or amputation No Yes Yes No In unresectable cases Only unresectable cases Yespreoperative, postoperative or brachytherapy Yes Curettage/grafting Wide to radical resection Adjuvant surgery (wide to marginal resection) improves outcome Curettage and bone graft for latent cysts or with steroid failure Curettage or marginal excision and grafting Curettage, followed by cementation or cryotherapy Wide resection or amputation and radiation Internal fixation of fractures or impending fractures or joint replacement

Soft tissue sarcoma Controversial as adjuvant; does benefit in metastatic disease Metastatic carcinoma Yes