PREDICTORS OF SURVIVAL OF MALIGNANT-TUMORS OF THE STERNUM

From 1930 to 1994, 54 patients with primary malignant tumors of the st ernum were seen. Fifty patients were first seen with a mass, and one h alf of them also had pain in the sternal region. Two patients had no s ymptoms at presentation. Among 39 solid tumors were 26 chondrosarcomas , 10 osteosarcomas, 1 fibrosarcoma, 1 angiosarcoma, and 1 malignant fi brous histiocytoma. Of these, 25 were low-grade and 14 were high-grade tumors. Among 15 small cell tumors were 8 plasmacytomas, 6 malignant lymphomas, and 1 Ewing's sarcoma. Partial or subtotal sternectomy was done in 37 patients and total sternectomy in 3. Of the remaining 14 pa tients, 3 had local excision; 10 had external radiation or chemotherap y without operation, or both; and 1 had no treatment. All but one pati ent treated by wide resection (N = 40) had some form of skeletal recon struction of the chest wall defect. Thirty-one (78%) underwent repair with Marlex mesh, and in 25 this was combined with methyl methacrylate . The skin edges were closed per primum in 32 patients; 8 required mus cle, omentum, or skin flaps. Resection in chondrosarcomas yielded a 5- year survival (Kaplan-Meier) of 80% (median follow-up, 17 years). The 5-year survival in osteosarcomas was 14%. Resection was curative in 64 % of low-grade sarcomas but in only 7% of high-grade sarcomas. In smal l cell tumors, resection and radiation were helpful for local control; all failures were a result of distant metastases. We conclude that pr imary sarcomas of the sternum though uncommon are potentially curable by wide surgical excision. With rigid prostheses to repair the skeleta l defects, the surgical complication rates are low. Overall survival a fter complete surgical resection is related to tumor histologic type a nd grade.