ABSTRACT
Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Extremities , Sarcoma/therapy , Soft Tissue Neoplasms/therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cisplatin/administration & dosage , Combined Modality Therapy , Doxorubicin/administration & dosage , Female , Fibrosarcoma/drug therapy , Fibrosarcoma/epidemiology , Fibrosarcoma/surgery , Floxuridine/administration & dosage , Histiocytoma, Benign Fibrous/drug therapy , Histiocytoma, Benign Fibrous/epidemiology , Histiocytoma, Benign Fibrous/surgery , Humans , Infusions, Intra-Arterial , Leiomyosarcoma/drug therapy , Leiomyosarcoma/epidemiology , Leiomyosarcoma/surgery , Liposarcoma/drug therapy , Liposarcoma/epidemiology , Liposarcoma/surgery , Male , Middle Aged , Retrospective Studies , Rhabdomyosarcoma/drug therapy , Rhabdomyosarcoma/epidemiology , Rhabdomyosarcoma/surgery , Sarcoma/drug therapy , Sarcoma/surgery , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/surgery , Survival RateABSTRACT
Two patients with unusual central nervous system sarcoid were investigated using computed tomography and magnetic resonance imaging, as well as other x-ray studies. A patient with intramedullary involvement of the spinal cord as well as nerve root involvement was examined. Follow-up examination after treatment with steroids showed a return to normal. The second patient had optic nerve involvement as well as two intracranial parenchymal lesions and granulomatous arachnoiditis. In this patient magnetic resonance imaging offered no advantages over computed tomography in the orbit but was significantly more accurate intracranially.
