AMPUTATION OF THE LOWER-LIMB AS PALLIATIVE TREATMENT FOR DEBILITATINGMUSCULOSKELETAL CANCER

Limb sparing surgery has replaced amputation surgery for treating sarc omas of the lower limb in most cases. Wide resection followed by posto perative radiation therapy can achieve acceptable local control and su rvival rates in patients with bone and soft-tissue sarcomas of the low er limb. Recurrent or persistent disease constitutes a major oncologic al problem. Local symptoms such as agonizing pain, fractures, tumor fu ngation, inability to walk and inability to maintain daily activities, further impair the patient's quality of life. In this clinical set-up palliative amputation of the limb should be considered. Fourteen pati ents with soft-tissue or bone sarcomas underwent palliative major ampu tation. The procedures included: hemipelvectomy, hip disarticulation, knee disarticulation, above or below-knee amputation. Local control of the disease and pain, and improvement of the performance status were observed in 13 evaluable patients. The mobility was restored in 13/14 patients. The median survival following the procedure was 9 months. Th ere was only one case of immediate post-operative death. Severe phanto m pain was not reported by any of the patients. Quality of life was re ported to be improved by two-thirds of the patients. We found palliati ve major amputation surgery worth-performing in low-performance status cancer patients with locally advanced disease of the lower limb.