title: Sarcomas of the flexor fossae in children: is amputation necessary?
abstract: Successful management of sarcomas of the extremities in children implies not only achievement of local control but also satisfactory function and maintenance of the growth potential. The popliteal and antecubital fossae, because of their complex neurovascular anatomy, all of which is essential, make resection with satisfactory margins difficult. We reviewed our experience with 14 patients (3 to 20 years old; median, 13 years) with soft tissue sarcomas arising in the popliteal (11 patients) or antecubital (3 patients) fossae. There were four rhabdomyosarcomas (3 alveolar, 1 embryonal) and 10 other sarcomas, the most frequent being synovial sarcoma (5 patients). Chemotherapy was given to all patients with rhabdomyosarcomas. The one patient presenting with metastatic disease was treated, after biopsy of the primary, by chemotherapy and radiation and survived 21 months. In three patients, the primary management was an above-the-knee amputation and two of three survived (3 and 43 months). In 10 patients a wide local excision of the primary tumor was performed. Radiation therapy was administered to five, either as external beam (3 patients) or as brachytherapy (2 patients). In this group, there were no local recurrences. Four patients remain free of disease (4 months to 18 years) and one developed pulmonary metastasis. Among the five non-irradiated patients, three developed local recurrences, requiring above-the-knee amputation for disease. The fourth patient relapsed in the lung and only one of the five is free of disease at 36 months. Of the 8 patients not treated with amputation, one acquired a leg length discrepancy, which required correction, and one has a minimal extension deficit of the knee.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery, St Jude Children's Research Hospital, University of Tennessee, Memphis 38103.
authors.forename: P G
authors.initials: PG
authors.lastname: Philippe
authors.forename: B N
authors.initials: BN
authors.lastname: Rao
authors.forename: D A
authors.initials: DA
authors.lastname: Rogers
authors.forename: J
authors.initials: J
authors.lastname: Fontanesi
authors.forename: L
authors.initials: L
authors.lastname: Bowman
authors.forename: D
authors.initials: D
authors.lastname: Parham
authors.forename: D
authors.initials: D
authors.lastname: Shapiro
authors.forename: T E
authors.initials: TE
authors.lastname: Lobe
authors.forename: I
authors.initials: I
authors.lastname: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004550:Elbow / Q000601:surgery*; D005260:Female; D006801:Humans; D007717:Knee / Q000601:surgery*; D007866:Leg / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012086:Reoperation; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012509:Sarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*