The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica.

During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.

The Evolution of Pediatric Soft Tissue Sarcoma Classification in the Last 50 Years.

This review discusses the history of the classification of soft tissue sarcomas in children and adolescents, the current transition toward integration of morphology and molecular genetics as new entities emerge, and future perspectives.

Pioneers in musculoskeletal oncology: Musculoskeletal Tumor Society Founders Lecture.

I was invited to deliver the third annual Musculoskeletal Tumor Society's Founder's Lecture, at our annual meeting on May 2, 2003 in Chicago, IL. The Musculoskeletal Tumor Society began in 1977 when a small group of physicians, mainly orthopaedic surgeons, met to discuss ways of improving the outcome of the rare and usually fatal primary malignant neoplasms of bone. Treatment of patients with these types of cancers most often was amputation. Initial criteria for membership included participation in group clinical studies. As individuals and collectively as a tumor society, we have witnessed and participated in a revolution in the care of these patients resulting in markedly increasing survival from less than 20% to nearly 70% and dramatically lessening disabilities by using limb-sparing surgery instead of amputation. I have elected to present brief descriptions of some of the individuals and their contributions that have led to these noteworthy improvements in patient care and final results. These individuals lived in different countries during different times and are from various fields of medicine. The time constraints imposed by the lecture have made it impossible to include all the deserving pioneers.

A system for the surgical staging of musculoskeletal sarcoma. 1980.

Historically, an adequate surgical procedure has been the most effective means of treating the majority of primary musculoskeletal sarcomas, and amputation has figured prominently in the surgical armamentarium. 4, 7, 9, 19, 21, 29, 41 The recent evidence that certain chemotherapeutic agents may have significant anti-sarcoma activity 2, 15, 17, 38 and coincident technical advances in irradiation therapy, radiographic localization, and reconstructive surgery have fostered enthusiastic interest in extremity-saving treatments. Almost all such treatments emphasize limb salvage as an alternative to amputation and are usually performed under a protective cloak of adjunctive chemotherapy, irradiation or immunoactive agents. 20, 23, 24, 30, 37, 39 Since neither chemotherapy nor irradiation therapy alone has been shown to assure long-term local control of bulk disease, surgical intervention remains an essential step in the overall management of musculoskeletal sarcomas. 3, 9, 17, 18, 29 Questions concerning the magnitude and timing of the surgical procedure are as unanswered as those relating to the most appropriate use of the adjuncts themselves. Increasingly, the surgeon and his patient are confronted with a bewildering array of therapeutic options, the long-term outcomes of which are unknown. These relatively rare sarcomas increasingly are distributed among a variety of treatment protocols in which multiple parameters differ. This trend necessitates interinstitutional cooperation if sufficient numbers of patients are to be available for the timely evaluation of treatments in clinical use. Such cooperation and even effective interinstitutional communication are seriously hampered by the lack of uniform language, so that meaningful comparison of treatments is currently impossible. Prime factors include the lack of a consistent definition of the surgery performed and a serviceable surgical staging system encompassing bone and soft tissue. Standard terminology will assure that like and unlike treatments are appropriately compared. Although an effective staging system should serve all members of the multidisciplinary team, the biologic behavior of musculoskeletal sarcomas suggests that the most useful staging system will articulate with the surgical procedure.