Introduction and historical review

Ernest Amory CodmanBone sarcoma is an ancient disease that is still incompletely understood. The term sarcoma was introduced by the English surgeon John Abernathy in 1804 and was derived from Greek roots meaning fleshy excrescence. In 1805, the French surgeon Alexis Boyer (personal surgeon to Napoleon) first used the term osteosarcoma. Boyer realized that osteosarcoma was a distinct entity from other bone lesions.
Under the auspices of the American College of Surgeons, Ernest Amory Codman (along with James Ewing and Joseph Bloodgood) created the Registry of Bone Sarcoma in 1921. This was a significant step forward in studying these rare and ominous tumors as individual surgeons had only limited experience to guide them.
James Ewing
Cooper and Travers first described giant cell tumor (GCT) of bone in 1818. James Ewing, first described the tumor that was to be named after him in the 1920’s.
By the mid 1900s, great strides were being made in the United States in the field of bone pathology by Henry L. Jaffe (1896-1979) and his colleague Louis Lichtenstein (1906-1977). Each of these men would publish textbooks devoted to bone pathology. Jaffe and Lichtenstein together established virtually all of the key histologic criteria used to diagnose most of the commonly encountered bone tumors. Norman Jaffe, along with other researchers, helped expand the use of a variety of effective chemotherapeutic agents in the 1970s and early 1980s. Not the least of these agents was adriamycin and methotrexate. These medications (and others that would follow) would dramatically improve the treatment of patients with osteosarcoma through their ability to treat the micrometastatic disease that was thought to be present in approximately 80% of patients. These drugs were found to be useful both preoperatively and postoperatively in patients with osteosarcoma, a discovery made at the Sloan-Kettering Memorial Cancer Center somewhat serendipitously while custom-made prostheses were being fabricated for patients awaiting surgery. Such preoperative use of chemotherapy would come to be referred to as neoadjuvant chemotherapy.
William F. Enneking
It would then only remain for an orthopedic surgeon from Gainesville, Florida,William F. Enneking, to introduce his surgical staging system for musculoskeletal sarcomas .This staging system helped organize the orthopedic surgical approach to both biopsy and definitive tumor resection for osteosarcoma, as well as for other musculoskeletal sarcomas.