SURGICAL-TREATMENT OF PRIMARY MALIGNANT CHEST-WALL TUMORS

Objective: Primary malignant tumours of the bony chest wall are uncomm on and data concerning treatment and results are sparse. Methods: To a ssess the results of surgical resection and chest wall reconstruction we reviewed our experience with primary malignant chest wall tumours t reated since 1958. Results: Of the 49 lesions, 42 were found in the ri bs and the remaining 7 in the sternum. These included chondrosarcomas [22], solitary plasmacytoma [18], Ewing's tumours [7], Askin's tumour [1] and Desmoid tumour [1]. Skeletal reconstruction was performed in 3 6 of the 49 patients. Marlex mesh alone was used in 17 patients. Since 1972, a sandwich of two layers of Marlex mesh with a filler of methyl methacrylate was utilised [19] successfully, producing better functio nal and cosmetic results. Primary soft tissue closure was possible in all but 8 cases in whom latissimus dorsi myocutaneous flaps were used. Bilaterally, partially transposed pectoralis major muscle was used to cover upper sternal defects in 4 cases. All but 1 patient had an unev entful post-operative recovery none requiring ventilatory support. Sur vival: Overall survival at 5 and 10 years was 68%. The differential fi gures for 10-year survival were for chondrosarcoma 67%, Ewing's sarcom a 43%, and solitary plasmacytoma 59%. These were the results of radica l en-bloc excisions. The patient with Desmoid tumour is alive at 5 yea rs, following incomplete initial resection and the patient with Askin' s tumour survived for 3 years. Conclusion: Radical en-bloc excision re mains the treatment of choice in all primary malignant chest wall neop lasms except large solitary plasmacytomas where incisional biopsy foll owed by irradiation appears to be the method of preference. In Ewing's and Askin's tumours, additional chemotherapy and radiotherapy have to be used. The extent of surgical excision should only be limited by th e amount of tissue necessary to remove for adequate malignant tissue c learance, since even large defects can be reconstructed with little fu nctional disturbance. (C) 1997 Elsevier Science B.V.