SOFT-TISSUE COMPLICATIONS OF INTRAARTERIAL CHEMOTHERAPY FOR EXTREMITYSARCOMAS

High-grade sarcomas have a high rate of local recurrence as well as di stant metastases. This has led to the development of intra-arterial ch emotherapy (IAC) as part of a multimodal approach to control local dis ease and/or reduce the extent of surgical resection. Intra-arterial ca theters are positioned by an interventional radiologist into the feedi ng vessels of the tumor. Adriamycin and 5-fluorodeoxyuridine ape infus ed intra-arterially. Cisplatinum, with or without granulocyte colony s timulating acute, is given systemically. Patients usually experience a cute self-limited soft-tissue inflammation in the treated area. In our experience of 118 patients, 3 patients experienced soft-tissue necros is that required excision and reconstruction. The first was treated fo r synovial sarcoma of a metatarsal. After IAC with Adriamycin, she slo ughed the skin, subcutaneous tissue, and some of the posterior compart ment musculature of her calf. This tissue was debrided. A gastrocnemiu s flap and skin graft were used for coverage. She is free of disease a nd ambulatory. The second patient was treated with IAC Adriamycin for a radial head chondrosarcoma, She developed soft-tissue slough, which became infected with Pseudomonas. She required extensive debridement o f the skin, subcutaneous tissue, and muscle, and was subsequently reco nstructed with a latissimus flap and a split-thickness skin graft (STS G). She later developed a local recurrence requiring amputation. The l atissimus was elevated and used to cover the distal stump. She also is free of disease. The third patient was treated with IAC Adriamycin fo r Ewing's sarcoma of the right femur. This was complicated by fat necr osis and persistent pain. Subsequent radiotherapy only worsened her sy mptoms. She underwent wide excision and muscle flap/STSG repair, which relieved her pain. She is currently ambulatory and free of disease. I n conclusion, as the use of IAC continues, its complications may becom e more common. Our experience with this previously unknown entity is i llustrated and therapeutic options are discussed.