[Limb salvage in osteosarcoma. Significance of preoperative isolation perfusion chemotherapy]

In our Department since 1960 isolation perfusion chemotherapy has been performed as a preoperative procedure combined with surgery in 134 patients with osteosarcoma of the extremity. In this paper, the significance of isolation perfusion chemotherapy was presented. The cumulative 5-year survival rate of 114 perfused patients was 42.7%, while that of 41 non-perfused patients before 1960 was 17.1%. Of the 114 patients 102 underwent amputation and 12 had limb salvage surgery. The cumulative 5-year survival rate of the 9 patients who have received limb salvage surgery since 1978 is 68%. Eleven patients who received preoperative aggressive chemotherapy including isolation perfusion chemotherapy showed a 91% clinical and radiological response to the drug. The tumor was microscopically analyzed and the ratio of necrotic to viable tumor cells was calculated. The degree of tumor necrosis was classified as excellent (greater than or equal to 95%), good (80-94%), fair (50-79%) and poor (less than 50%). The response in 22 patients who received preoperative aggressive chemotherapy using adriamycin, methotrexate and cis-platinum including the use of isolation perfusion was excellent in 41%, good in 36%, fair in 14% and poor in 9%. We believe that preoperative isolation perfusion chemotherapy is an effective procedure for limb salvage surgery.