Use of Intra-Arterial Chemotherapy and Embolization Before Limb Salvage Surgery for Osteosarcoma of the Lower Extremity View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-03-19

AUTHORS

Huo-Jun Zhang, Ji-Jin Yang, Jian-Ping Lu, Chao-Jen Lai, Jin Sheng, Yu-Xiao Li, Qiang Hao, Shun-Min Zhang, Sanjay Gupta

ABSTRACT

We report our experience with the use of intra-arterial chemotherapy and embolization before limb salvage surgery in patients with osteosarcoma of the lower extremity. We evaluated the effect of this procedure on the degree of tumor necrosis and on the amount of blood loss during surgery. We reviewed the medical records of all patients who received intra-arterial chemotherapy and embolization before undergoing limb salvage surgery for osteosarcoma of the lower extremity at our institution between January 2003 and April 2008. Patient demographic, tumor characteristics, treatment details, postembolization complications, and surgical and pathological findings were recorded for each patient. We evaluated the operative time, estimated blood loss (EBL), and volume of blood transfusion during surgery and in the postoperative period in all patients in the study group. The same parameters were recorded for 65 other patients with lower extremity osteosarcoma who underwent limb salvage operation at our institution without undergoing preoperative intervention. The study included 47 patients (25 males and 22 females). Angiography showed that the tumors were hypervascular. Intra-arterial chemotherapy and embolization were performed successfully, resulting in a substantial reduction or complete disappearance of tumor stain in all patients. No major complications were encountered. At the time of surgery, performed 3–7 days after embolization, a fibrous edematous band around the tumor was observed in 43 of the 47 patients, facilitating surgery. The goal of limb salvage was achieved successfully in all cases. Percentage tumor necrosis induced by treatment ranged from 70.2% to 94.2% (average, 82.9%). EBL during surgery, EBL from drains in the postoperative period, total EBL, and transfusion volumes were significantly lower in the 47 study patients compared to the 65 patients who underwent surgery without preoperative treatment with intra-arterial chemotherapy and embolization. The mean operative time was also significantly less in the intervention group compared to the nonintervention group (73.2 vs. 88.5 min; p < 0.05). In conclusion, intra-arterial chemotherapy and embolization performed 3 to 7 days before limb salvage surgery in patients with lower extremity osteosarcomas can cause substantial tumor necrosis, reduce the EBL and transfusion requirements during surgery, and induce formation of a false capsule around the tumor, thus facilitating surgical excision of the tumors. More... »

PAGES

672-678

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00270-009-9546-2

DOI

http://dx.doi.org/10.1007/s00270-009-9546-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1004606403

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19296158


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34 schema:description We report our experience with the use of intra-arterial chemotherapy and embolization before limb salvage surgery in patients with osteosarcoma of the lower extremity. We evaluated the effect of this procedure on the degree of tumor necrosis and on the amount of blood loss during surgery. We reviewed the medical records of all patients who received intra-arterial chemotherapy and embolization before undergoing limb salvage surgery for osteosarcoma of the lower extremity at our institution between January 2003 and April 2008. Patient demographic, tumor characteristics, treatment details, postembolization complications, and surgical and pathological findings were recorded for each patient. We evaluated the operative time, estimated blood loss (EBL), and volume of blood transfusion during surgery and in the postoperative period in all patients in the study group. The same parameters were recorded for 65 other patients with lower extremity osteosarcoma who underwent limb salvage operation at our institution without undergoing preoperative intervention. The study included 47 patients (25 males and 22 females). Angiography showed that the tumors were hypervascular. Intra-arterial chemotherapy and embolization were performed successfully, resulting in a substantial reduction or complete disappearance of tumor stain in all patients. No major complications were encountered. At the time of surgery, performed 3–7 days after embolization, a fibrous edematous band around the tumor was observed in 43 of the 47 patients, facilitating surgery. The goal of limb salvage was achieved successfully in all cases. Percentage tumor necrosis induced by treatment ranged from 70.2% to 94.2% (average, 82.9%). EBL during surgery, EBL from drains in the postoperative period, total EBL, and transfusion volumes were significantly lower in the 47 study patients compared to the 65 patients who underwent surgery without preoperative treatment with intra-arterial chemotherapy and embolization. The mean operative time was also significantly less in the intervention group compared to the nonintervention group (73.2 vs. 88.5 min; p < 0.05). In conclusion, intra-arterial chemotherapy and embolization performed 3 to 7 days before limb salvage surgery in patients with lower extremity osteosarcomas can cause substantial tumor necrosis, reduce the EBL and transfusion requirements during surgery, and induce formation of a false capsule around the tumor, thus facilitating surgical excision of the tumors.
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41 Lower Extremity
42 amount
43 angiography
44 band
45 blood loss
46 blood transfusion
47 capsule
48 cases
49 characteristics
50 chemotherapy
51 complete disappearance
52 complications
53 conclusion
54 days
55 degree
56 detail
57 disappearance
58 drain
59 effect
60 embolization
61 excision
62 experience
63 extremities
64 extremity osteosarcoma
65 false capsule
66 findings
67 formation
68 goal
69 group
70 institutions
71 intervention
72 intervention group
73 intra-arterial chemotherapy
74 limb salvage
75 limb salvage operation
76 limb salvage surgery
77 loss
78 lower extremities
79 lower extremity osteosarcoma
80 major complications
81 mean operative time
82 medical records
83 necrosis
84 nonintervention group
85 operation
86 operative time
87 osteosarcoma
88 parameters
89 pathological findings
90 patients
91 percentage tumor necrosis
92 period
93 postembolization complications
94 postoperative period
95 preoperative intervention
96 preoperative treatment
97 procedure
98 records
99 reduction
100 requirements
101 salvage
102 salvage operation
103 salvage surgery
104 same parameters
105 stain
106 study
107 study group
108 study patients
109 substantial reduction
110 substantial tumor necrosis
111 surgery
112 surgical excision
113 time
114 time of surgery
115 total EBL
116 transfusion
117 transfusion requirements
118 transfusion volume
119 treatment
120 treatment details
121 tumor characteristics
122 tumor necrosis
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