Soulen M C, Weissmann J R, Sullivan K L, Lackman R D, Shapiro M J, Bonn J, Weiss A J, Gardiner G A
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA.
J Vasc Interv Radiol. 1992 Nov;3(4):659-63. doi: 10.1016/s1051-0443(92)72918-2.
Fifteen patients with large (average, 15-cm), high-grade soft-tissue sarcomas of the extremities received prolonged selective intraarterial infusions of chemotherapeutic agents in an attempt to permit limb-sparing resection of these tumors, which would otherwise have required amputation. There were seven malignant fibrous histiocytomas, four liposarcomas, two fibrosarcomas, one leiomyosarcoma, and one rhabdomyosarcoma; 73% were grade III. Seven patients underwent two catheterizations, for a total of 22 infusions, which averaged 11.3 days each. There were four catheterization-related complications, including catheter occlusion or dislodgement in one patient each and two cases of arterial thromboembolism in patients in whom anticoagulant dose was not adequate. Both of the latter patients required thrombectomy; one developed gangrene, which precluded limb-sparing surgery. Thirteen of the 15 patients underwent limb-sparing resections, and two underwent amputations. No wound complications occurred. With a median follow-up of 36 months (mean, 34 months), life-table analysis indicates overall and disease-free survivals of 72% and 59%, respectively, at 2 years and 64% and 59% at 3 years. In comparison to other reported therapies, this technique permits limb salvage in most patients without the high wound complication rate associated with preoperative radiation therapy, with equivalent local disease control and survival.
15例患有四肢大型（平均15厘米）、高级别软组织肉瘤的患者接受了长时间的选择性动脉内化疗药物输注，试图对这些肿瘤进行保肢切除，否则这些肿瘤将需要截肢。其中有7例恶性纤维组织细胞瘤、4例脂肪肉瘤、2例纤维肉瘤、1例平滑肌肉瘤和1例横纹肌肉瘤；73%为III级。7例患者接受了两次导管插入术，共进行了22次输注，每次平均11.3天。有4例与导管插入术相关的并发症，包括1例导管阻塞或移位，以及2例抗凝剂量不足患者发生的动脉血栓栓塞。后两名患者均需要进行血栓切除术；其中1例发生坏疽，无法进行保肢手术。15例患者中有13例接受了保肢切除术，2例接受了截肢术。未发生伤口并发症。中位随访36个月（平均34个月），生命表分析表明，2年时总体生存率和无病生存率分别为72%和59%，3年时分别为64%和59%。与其他报道的治疗方法相比，该技术可使大多数患者保肢，且无术前放疗相关的高伤口并发症发生率，局部疾病控制和生存率相当。
