Primary
tumors of the chest wall are uncommon but should be considered in the evaluation of patients with persistent chest wall
pain or the presence of a chest wall mass, especially when this is near the costal cartilages. Special radiographic techniques may help to define the diagnostic possibilities and the extent of local involvement. Since at least half of the primary rib
tumors and virtually all of the sternal
tumors are malignant, these problems demand prompt investigation, accurate tissue diagnosis, and, usually, generous surgical excision. With appropriate attention to skin, soft tissue, and skeletal involvement, resection of major chest wall
tumors can be done safely, and there are a variety of reconstructive techniques available to deal with the resulting defects.
Radiotherapy has little role in the treatment of chest wall
tumors except for the
myeloproliferative disorders and possibly some cases of
Ewing's sarcoma.
Chemotherapy has similarly been ineffective for the cartilaginous
tumors but shows some promise in the multidisciplinary approach to
osteogenic sarcoma. Surgical resection, however, remains the mainstay for the treatment of most
tumors of the chest wall. Even in instances of recurrent disease there are many whose long-term survival has been achieved by multiple operative procedures.