Limb Salvage from a Multidisciplinary Treatment Approach for Skeletal and Soft Tissue Sarcomas of the Extremity

Abstract

Multimodality management of extremity skeletal and soft tissue sarcomas with preoperative intra-arterial Adriamycin and radiation therapy, radical surgical resection and postoperative chemotherapy or chemo-immunotherapy has resulted in preservation of a functional extremity in 13 or 14 patients. Seven of 8 patients with Stage IIIA and IIIB soft tissue sarcomas, managed with preoperative intra-arterial Adriamycin and radiation therapy, followed by en bloc soft tissue resection and 6 patients with bone sarcomas managed by preoperative treatment, followed by bone resection and replacement with cadaver bone allografts, remained free of disease from 4 to 34 months. The results of the combined modality approach were significantly better than the results obtained in patients managed by surgical resection alone, or by combination of operation with another single modality, both in terms of short term-recurrence free survival and salvage of a functional extremity.

A note from history: Landmarks in history of cancer, part 7

“…283 Although thoughts about limb-sparing surgery surfaced before 1970, 6 the first clinical application of the technique for skeletal and soft tissue sarcomas in adults using a multidisciplinary approach was published in the mid-1970s. 284,285 The results of cumulative experience with limb-sparing surgery combined with adjuvant therapy were so impressive that the technique became accepted at a consensus conference in 1984, 286 and it became a standard procedure before the end of 1995. 287 Function-saving resection followed by brachytherapy also was identified as a promising alternative to amputation.…”

In Memoriam: Donald L. Morton, MD (1934–2014): An Icon in Surgical Oncology

“…5 He was also one of the pioneers for performing limb salvage surgery and pulmonary metastasectomy for soft tissue sarcomas. 6 Although all of these made significant advances using the instruments of clinical trials, Dr. Morton was also a translational researcher who made fundamental discoveries in the field of tumor immunology and immunotherapy that has stimulated an entire field of inquiry.When Dr. Morton's scientific journey is examined from the perspective of a surgical investigator, he has few peers. He defined his approach as follows: ''Our goal as cancer researchers is to make things better.…”

Distal Femoral Resection with Endoprosthetic Reconstruction

“…malignant fibrous histiocytoma, fibrosarcoma, and malignant giant cell tumors). [1][2][3][4][5][6][7][8] Almost all low-grade sarcomas of the distal femur, especially parosteal osteosarcoma and chondrosarcoma, can be treated safely with a limb-sparing resection. Careful preoperative planning and patient selection are crucial to a successful outcome.…”

“…These factors, taken together, determine the adequacy of the length of the resection. The femoral condyle component is placed onto the distal end of the femoral body component (5). The entire prosthesis is removed from the impaction tube and placed with the femoral condyles against the assembly pad.…”

“…[1][2][3][4][5] The continuous disease-free survival rates in patients who have undergone resection are the same as or better than those of patients undergoing amputation; presumably because of the use of appropriate selection criteria. Eckardt et al 6 reported their experience at the University of California at Los Angeles with Stage IIB osteosarcoma for the period 1972-84.…”