LIMB SALVAGE SURGERY FOR WIDELY INFILTRATING BONY SARCOMAS

Objective: To determine whether neoadjuvant chemotherapy and radiother apy for bony sarcomas extending into soft tissues would allow limb sal vage yet maintain local disease control. Design: A prospective cohort study. Setting: A university-affiliate cancer centre in Alberta. Patie nts: All patients with potentially curable, widely infiltrating bony s arcomas of the extremity without neurologic deficit, referred to the c entre 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. Interventions: 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 late r the tumour was excised surgically, with placement of a bone allograf t or prosthesis, allowing a l-cm margin of healthy soft tissue and a 5 -cm margin of healthy bone and marrow cavity whenever possible. Main O utcome Measures: Need for limb amputation, infectious complications, r ecurrence of local regional disease. Results: One patient underwent am putation after fracture through the tumour site. There were two postop erative infections, one acute and one chronic. All patients had full n eurologic function of the distal limb. There was no local or regional recurrence of disease. Conclusion: Neoadjuvant chemotherapy followed b y radiotherapy and tumour excision provides control of aggressive loca l bone sarcomas while maintaining limb integrity.