The significance of preoperative chemotherapy for thermopreservation of limbs

: Preoperative chemotherapeutic effects on 42 osteosarcomas treated with CDDP intra-arterial infusion protocol were compared with the effects of treatment of same by local perfusion only, following administration of adriamycin (ADR) or high doses methotrexate and leucovorin (HD-MTX). Thirteen cases were further given local hyperthermic perfusion (LHP) treatment. The preoperative local treatment resulted in a poor response in cases in which the serum ALP failed to fall down the normal range, those with angiographically demonstrated tumor stains remaining, and those with reactive zones remaining as indicated by T2 MR imaging. The ratios of necrotic areas were significantly higher in the LHP group, while those of viable areas were significantly lower in the LHP group compared to other groups. Total tumor cell killing was possible in six of 13 cases in the LHP group. Post-necrotic fibrosis and post-necrotic osteosclerosis were significantly higher in the LPH group. The results suggested that, in selected cases treated with LHP, conservative surgery may well be possible so as to preserve all functional activity.