Taxol이 악성 골종양 세포에 어느 정도의 세포독성이 있는지를 평가하기 위해 한국세포주 은행에서 분양 받은 G-292, SaOS-2 및 HT-1080의 3가지 악성 골종양 세포들을 대상으로 기존의 항암제인 methotrexate, adriamycin, ifosfamide, cisplatinum과 함께 각각 투여하여 MTT분석법으로 정량 및 비교 분석하였으며, adriamycin과 taxol을 병용 투여하여 항암제의 상호작용을 isobologram 분석법으로 조사하여 다음과 같은 결과를 얻었다. 1. Taxol의 악성 골종양 세포 주들에 대한 $IC_{50}$는 G-292에서는 $2.7{\times}10^{-2}{\mu}g/ml$, $SaOS^{-2}$에서는 $1.0{\times}10^{-2}{\mu}g/ml$, $HT{\times}1080$에서는 $1.1{\times}10^{-3}{\mu}g/ml$이었다. 2. Taxol은 악성 골종양 세포주들에 대해 기존의 항암제들 보다 강한 세포독성을 보였으며, 기존 항암제의 세포 독성의 강도는 adriamycin이 제일 높은 역가를 보였으며 그 외 methotrexate, cisplatinum, ifosfamide순이었다. 3. Taxol과 adriamycin을 병용 투여하여 상호작용을 관찰한 결과 G-292와 SaOS-2 세포 주에서 상승효과가 관찰되었으며, HT-1080에서는 상승효과가 관찰되지 않았다.

A limb-sparing operation has a definitive role in the treatment of osteosarcoma in the lower extremity of skeletally-immature patients. After a limb-sparing operation, leg length discrepancy remains as a major disability that should be corrected. This study was designed to suggest methods of tumor resection and proper timing of leg length equalization in skeletally immature osteosarcoma patients. From September 1990 to January 1998, we reviewed eight osteosarcoma patients in an immature skeletal age. There were 4 males and 4 females, and their mean duration of follow-up was 50.37 months (range : 25 to 88 months). Mean skeletal age was 8 years (range : 8 months to 11 years). The patients were classified according to the methods of tumor resection ; intercalary resection in 1 case, transepiphyseal resection in 1, intra-articular resection in 5, and extra-articular resection in 1. The results were as follows ; 1. The leg lengthening was begun when a patient's leg length discrepancy reached 4-5cm. 2. The age of final lengthening with permanent reconstruction was 14 years in males and 12 years in females (about 2 years before skeletal maturity). 3. When reconstruction was performed with a temporary spacer, the site of lengthening Was in the soft tissue, not in bone, and then a permanant reconstruction was done. 4. Reconstruction with a biologic spacer to preserve the joint function was a reasonable method for equalization of leg length. In conclusion, the appropriate choice of reconstructive method and the age at which to correct the leg length discrepancy in a skeletally-immature osteosarcoma patients are important factors for maintaining leg length at full maturity.

Squamous cell carcinoma is a neglected disease entity in orthopedic oncology. The purpose of this study was to analyze overall survival and the role of surgery on survival and to evaluate the significance of possible prognostic factors. From Oct, 1986 to Aug, 1996, 57 patients were enlisted and 42 patients ere eligible. Inclusion criteria included more than one year follow-up and no distant metastasis at the first visit. Staging and survival followed AJC classification and Kaplan-Meier plot. Stage II included 17 cases and stage III, 25 cases. Thirty-eight patients underwent operations, chemotherapy, and/or radiotherapy, and the remaining four had operations only. The chemotherapeutic regimen was adriamycin-cisplatin. The average follow-up period was 45 months. The ten-year actuarial survival rate of whole patients was 65.4%. Location of primary lesion, stage, pathologic grading, and intensity of chemotherapy in the same stage showed a significant difference in survival. Nine out of 42 patients had local recurrence. Seven patients had inadequate wide margins and two had intralesional margins. Average period of recurrence from operation was 13(4-35)months. The operation itself had no impact on survival but a surgical margin of no less than 3cm from the lesion was important for local control. Pathological grade and staging were significant variables for long term survival. Acral lesion had a significantly higher chance of regional and distant metastasis but actual survival showed no difference. In stage II, aggressive chemotherapy could delay or reduce the chance of regional or distant metastasis.

Between 1992 and 1996, 5 patients with the giant-cell tumor of the spine were treated. Four were female and one was male. The mean age was 34 years old, and the mean follow-up time was 36 months. The locations of the lesions were the cervical spine in 1, the thoracic spine in 3, and the lumbar spine in 1. Pain was the predominant presenting symptom in all cases and four had a neurological deficit. A combined anterior and posterior surgical approach wds as performed in all cases, which were also treated with AIF(anterior interbody fusion) and anterior and/or posterior instrumentation. Adjuvant radiation therapy was performed in 1 case of cervical spine. At the final follow-up, the pain and neurologic symptoms were improved. Radiologic examination showed no evidence of local recurrence and no failure of instrumentation of the spine.

We treated 19 cases of unicameral bone cysts with methylprednisolone acetate (MPA) from January 1988 to December 1995. We evaluated the effect of MPA injections through simple follow-up radiographs according to Oppenheim's, classification and retrospectively reviewed the sites of cyst, age of the patients at diagnosis, the incidence of pathologic fracture, cystic nature, and cystic proximiy to the growth plate, We then analyzed the relationship between these variables with the results of MPA injections. According to Oppenheim's classification, the results with the use of MPA injections were as follows: healed in six cases, improved in seven cases, incomplete obliteration in five cases and recurred in one case, If healed and improved were considered satisfactory results, then 13 cases(68.4%) were satisfactory at the last follow-up. Sites of cyst, age of the patients at diagnosis, incidence of pathologic fracture, cystic nature and cystic proximiy to the growth plate appeared not to influence the results of MPA injections statistically. On these data, we thought that the treatment of unicameral bone cysts with MPA injection was the most effective first choice of treatment before operative options such as curettage and bone graft.

Limb-salvage surgery has become more popular than amputation for the treatment of malignant bone tumor because no differences in local recurrence and the 5-year survival rate have been found. However for young patients with sarcoma, skeletal immaturity may be a contraindication to limb-salvage surgery due to the expected leg length discrepancy. If limb-sparing procedure should be impossible for skeletally immature patients, amputation has to be given first consideration. To minimize the functional difficulty from short amputation stump of above knee amputation, we performed lengthening of the amputation stump using ipsilateral tibia. One patient was lengthened 17cm using ipsilateral tibia and the other, 12cm. Two patients and their families were satisfied both clinically and psychologically.

Parosteal osteosarcoma is characterized as a densely ossifying lesion, usually occurring on the surface near the metaphyses of a long bone. The histological pattern is a well- differentiated mature bone trabeculae with a hypocellular spindle-cell stroma. The cytological details are those of a low-grade malignant lesion. The natural history of this lesion is indolent local growth, late invasion of the underlying bone, and infrequently, distant metastasis. However, there is a significant risk of eventual dedifferentiation into a high-grade lesion. We report here-a case of parosteal osteosarcoma dedifferentiated into a high-grade lesion, which occurred in the left distal femur of a 40-years-old woman, and discuss the experience in detail.

Osteosarcoma is the most common primary bone tumor except for multiple myeloma. Hematogenous spread of osteosarcoma presents the t1susal route of dissemination. Lung metastasis is the most common, however the lymph node involvement is quite rare. In addition, according to Mirra, radiologically detectable involvement of lymph node is an extremely rare manifestation of osteosarcoma. The authors had experienced a patient with an osteosarcoma of the right distal femur which spread to the right inguinal lymph node and lung. After preoperative chemotheraphy, a limb salvage operation was performed around the lesion of right distal femur and the right inguinal lymph nodes were dissected. A adjuvant postoperative chemotheraphy was performed. After the treatment, there was no recurrence of osteosarcoma or any other metastatic evidence for two years and 8 months.