Effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery.
BACKGROUND
This study examined the effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery.


METHODS
One hundred seven patients with malignant bone and soft tissue tumors were administered intra-arterial cisplatin and caffeine preoperatively with or without doxorubicin. Nine patients (8.4%) who had had myocutaneous inflammatory reactions were reviewed to determine the effects of this complication on limb-saving surgery.


RESULTS
The patients complained of unbearable and continuous pain while undergoing intra-arterial infusion. Gait disturbances and muscle weakness were caused by their severe regional pain, resulting in the use of crutches even before surgery. Extended areas of necrotic skin and muscle were resected simultaneously with limb-saving surgery on four patients. Myocutaneous necrosis in one patient, indurations in two patients, and flares in two patients were not treated surgically. Pain relief was provided to eight patients at some point. Four patients with extensive myocutaneous necrosis around the knee joint had restricted range of motion and poor functional results. Radionuclide angiography using 99m-Technetium-macroaggregated albumins was performed to evaluate the blood flow to the affected muscle and tumor. It showed marked increase of the radioisotope perfusion in the affected muscles but little uptake in the tumor. These results may suggest that the affected muscles diminish the effects of anticancer drugs on the tumors.


CONCLUSIONS
Myocutaneous inflammatory reactions should be prevented if possible to obtain good limb function and chemotherapeutic effects in patients who undergo intra-arterial chemotherapy. Resection of necrotic tissue is mandatory to relieve pain.
Tsuchiya
H
H
Department of Orthopedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan. tsuchi@med.kanazawa-u.ac.jp
Morinaga
T
T
Taki
J
J
Sumiya
H
H
Matsui
O
O
Tomita
K
K
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D002110:Caffeine / Q000008:administration & dosage; D002648:Child; D003131:Combined Modality Therapy; D003872:Dermatitis / Q000000981:diagnostic imaging / Q000209:etiology*; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000009:adverse effects*; D008297:Male; D009220:Myositis / Q000000981:diagnostic imaging / Q000209:etiology*; D009336:Necrosis; D012516:Osteosarcoma / Q000628:therapy; D011877:Radionuclide Imaging; D016879:Salvage Therapy; D013584:Sarcoma, Synovial / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002110:Caffeine; D004317:Doxorubicin