Limb salvage surgery for widely infiltrating bony sarcomas.
OBJECTIVE
To determine whether neoadjuvant chemotherapy and radiotherapy for bony sarcomas extending into soft tissues would allow limb salvage yet maintain local disease control.


METHODS
A prospective cohort study.


METHODS
A university-affiliated cancer centre in Alberta.


METHODS
All patients with potentially curable, widely infiltrating bony sarcomas of the extremity without neurologic deficit, referred to the centre in the 6 years from January 1984 to December 1990. There were 11 patients; 1 did not complete the protocol. The mean follow-up was 24 months.


METHODS
Adriamycin (doxorubicin) was infused for 3 days at a rate of 30 mg/d. A few days later radiotherapy was given 5 days a week for 10 doses at a rate of 3.0 Gy per dose. Four to 5 weeks later the tumour was excised surgically, with placement of a bone allograft or prosthesis, allowing a 1-cm margin of healthy soft tissue and a 5-cm margin of healthy bone and marrow cavity whenever possible.


METHODS
Need for limb amputation, infectious complications, recurrence of local or regional disease.


RESULTS
One patient underwent amputation after fracture through the tumour site. There were two postoperative infections, one acute and one chronic. All patients had full neurologic function of the distal limb. There was no local or regional recurrence of disease.


CONCLUSIONS
Neoadjuvant chemotherapy followed by radiotherapy and tumour excision provides control of aggressive local bone sarcomas while maintaining limb integrity.
Temple
W J
WJ
Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Alta.
Alexander
F
F
Arthur
K
K
Schachar
N S
NS
D001859:Bone Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004317:Doxorubicin / Q000627:therapeutic use; D005269:Femur; D005500:Follow-Up Studies; D006801:Humans; D009361:Neoplasm Invasiveness; D011829:Radiation Dosage; D012086:Reoperation; D016879:Salvage Therapy; D012509:Sarcoma / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000628:therapy
D004317:Doxorubicin