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PubMed1992

[A case of extra-adrenal pheochromocytoma with frostbite in extremities].

We describe a patient who presented frostbite in extremities in addition to characteristic symptoms, such as severe hypertension, sweating attacks, palpitations and headache. The patient was eventually diagnosed as having single extra-adrenal pheochromocytoma. The frostbite in extremities rapidly resolved after the removal of the tumor as well as other characteristic clinical symptoms. It is speculated that this frostbite might have been induced by severe continuous constriction of peripheral artery and loss of heat by frequent sweating attacks. Regarding cutaneous symptoms in this disease, pallor, acrocyanosis and cold extremities are commonly found. However, it seems that typical frostbite associated with pheochromocytoma has not been reported so far.

Adult↗
PubMed2003

[The effects of surgical margins on local control and survival in extremity soft tissue sarcomas].

OBJECTIVES: We evaluated the effects of surgical margins and other prognostic factors on local control and survival in extremity soft tissue sarcomas. METHODS: The study included 40 patients (34 males, 6 females; mean age 45 years; range 13 to 77 years) who underwent treatment for extremity soft tissue sarcomas. Of these, 14 patients presented with recurrences following treatment elsewhere. Preoperatively, nine patients and eight patients; postoperatively, 35 patients and 25 patients received radiotherapy and chemotherapy, respectively. Limb-salvaging surgery was performed in 35 patients (87.5%), of whom 28 patients (70%) received an extended resection, and seven patients received a marginal resection. Five patients (12.5%) required amputation. Negative surgical margins were achieved in 34 patients (85%), while six patients (15%) had positive surgical margins. The mean follow-up period was 58 months (range 13 to 124 months). RESULTS: Five patients (12.5%) developed local recurrences following marginal resection (n=4), and amputation. No local recurrences were seen in patients receiving an extended resection or in those having negative surgical margins. Five-year survival rates were 51% and 49% in patients whose initial diagnoses were made in our department and elsewhere, respectively. Significant correlations were found between extended resection (p=0.0001) and negative surgical margins (p=0.0001) and local control; and between tumor grade and survival (p=0.002). Positive surgical margins and local recurrences did not decrease survival. CONCLUSION: Achievement of negative surgical margins promotes local control in extremity soft tissue sarcomas. A careful preoperative planning and utilization of neoadjuvant therapies highly increase the possibility of negative surgical margins.

Adolescent↗
PubMed2004

Evidence-based rating of upper-extremity motor function tests used for people following a stroke.

INTRODUCTION: Tests of upper-extremity motor function used for people following a stroke have been described, but reliability and validity (psychometric properties) of measurements obtained with these tests have not been consistently established. This investigation was performed: (1) to review literature relative to upper-extremity motor function testing during rehabilitation following a stroke, (2) to develop selection criteria for identifying these tests in the literature, and (3) to rate the tests relative to their psychometric properties. METHOD: Literature searches were done using 2 databases. Reports of 4 psychometric properties were sought: interrater reliability, test-retest reliability, convergent validity or concurrent validity, and predictive validity. RESULTS: Nine tests met the inclusion criteria of having psychometric properties reported in the literature. No test had evidence for all 4 psychometric properties. Only the Nine-Hole Peg Test was supported by 3 out of 4 properties. Most tests had 2 properties supported. Concurrent validity or convergent validity was most frequently described; test-retest reliability was least frequently described. CONCLUSIONS: More complete psychometric support is needed for upper-extremity motor function tests applied following a stroke. The absence of psychometric support, however, does not mean that a test has no value. Clinicians are cautioned not to generalize psychometric evidence.

Disability Evaluation↗
PubMed2004

Costs of follow-up after potentially curative treatment for extremity soft-tissue sarcoma.

Soft-tissue sarcoma is an uncommon cancer with the potential for high rates of recurrence after initial therapy. Multiple surveillance strategies have been developed to follow patients after primary treatment. The purpose of this study was to quantify the costs associated with various published post-treatment surveillance strategies. A literature review covering the years 1982-2003 was performed to find all modern published surveillance methods for extremity soft-tissue sarcoma. Only articles describing an explicit 5-year follow-up strategy were included. Total costs of 5-year follow-up were calculated for each strategy using Medicare-allowed charges as a proxy. Thirty-four articles depicting 54 strategies were identified. Total Medicare-allowed charges in year 2003 dollars ranged from 485 dollars for follow-up of low-grade sarcoma to 21,235 dollars for follow-up of high-grade sarcoma, a 42.8-fold cost differential. The average charge for these 54 strategies was 6,401 dollars. Physical examination and chest x-ray were the most commonly used screening modalities. Several guidelines have been proposed for extremity soft-tissue sarcoma patient follow-up, most prominently those of the National Comprehensive Cancer Network. The literature has yet to reflect the consensus these guidelines suggest. This study shows wide disparity in the costs of 54 specific methods of following soft-tissue sarcoma patients. Clinical trials are needed to identify an optimal surveillance strategy, one balancing gains in survival, quality of life, costs, and societal willingness to expend resources. Such trials have not been conducted due to the rarity of extremity soft-tissue sarcomas and the costs associated with conducting long-term trials. Alternatively, prospective evaluation of imaging modalities used in follow-up should be assessed as part of other trials. Computer simulation analysis also holds great promise as an assessment tool for surveillance strategies because patient participation is not required.

Extremities↗
PubMed2004

Chronic lower extremity ischemia: a human model of ischemic tolerance.

BACKGROUND: Ischemic preconditioning (IPC) has been found in animals to have a protective effect against future ischemic injury to muscle tissue. Such injury is unavoidable during some surgical procedures. To determine whether chronic ischemia in the lower extremities would imitate IPC and reduce ischemic injury during vascular surgery, we designed a controlled clinical study. PATIENTS AND METHODS: Two groups of patients at a university-affiliated medical centre with chronic lower-extremity ischemia served as models of IPC: 6 patients awaiting femoral distal bypass (FDB) and 4 scheduled for aortobifemoral (ABF) bypass grafting for aortoiliac occlusive disease. Seven patients undergoing elective open repair of an infrarenal abdominal aortic aneurysm (AAA) were chosen as non-IPC controls. Three hematologic indicators of skeletal-muscle injury, lactate dehydrogenase (LDH), creatine kinase (CK) and myoglobin, were measured before placement of the proximal clamp, during surgical ischemia, immediately upon reperfusion, 15 minutes after and 1 hour after reperfusion, and during the first, second and third postoperative days. RESULTS: Baseline markers of skeletal-muscle injury were similar in all groups. In postreperfusion samples, concentrations of muscle-injury markers were significantly lower in the 2 PC groups than in the control group. For example, at day 2, LDH levels were increased by about 30% over baseline measures in the elective AAA (control) group, whereas levels in the FDB and ABF groups remained statistically unchanged from baseline. Myoglobin in controls had increased by 977%, but only by 160% in the FDB and 528% in the ABF groups. CK levels, in a similar trend, were 1432% higher in the control group and only 111% (FDB) and 1029% (ABF) in the study groups. Taken together, these data represent a significant level of protection. CONCLUSIONS: Patients with chronic lower-extremity ischemia suffered less severe ischemic injury after a period of acute ischemia than those with acute ischemia alone. Ischemic preconditioning is one proposed mechanism to help explain this protective effect.

Aged↗
PubMed2004

[Report on the investigation of lower extremity osteonecrosis with magnetic resonance imaging in recovered severe acute respiratory syndrome in Guangzhou].

OBJECTIVE: To report the occurrence of lower extremity avascular abnormalities in 124 cases of recovered severe acute respiratory syndrome (SARS) health care workers of four hospitals in Guangzhou and preliminary investigate the correlation with the treatment of steroid. METHODS: 124 health care workers with recovered SARS from four hospitals in Guangzhou were examined with MR imaging of the lower extremity including bilateral hips and knees. In 124 health care workers, 38 cases have not treated with steroid, while 86 cases have treated with varied dosage. The imaging protocol was consisted of screening and full examination. Coronal T1-weighted imaging and short tau inversion recovery sequence were defined as the screening examination. The full examination was defined as images from the screening examination plus three additional imaging sequences: transverse and coronal T2-weighted imaging and short tau inversion recovery sequence. RESULTS: In 86 health care workers, 5 cases were found positive in the lower extremity. Osteonecrosis was found in 3 cases. One was involved in bilateral femoral head, and another was unilateral femoral head, and the remaining one was bilateral femoral heads and unilateral femoral condyle and tibial condyle. Bilateral femoral and tibial marrow edema were found in one case. Femoral infarction with significant calcification occurred in one health care worker. Logistic regression analysis indicated that the presence of avascular abnormalities was related with maximum daily dosage. CONCLUSION: Osteonecrosis definitely exists in the minority of health care workers with recovered SARS in Guangzhou, who had treated with steroid. The maximum daily dosage of steroid may significantly influence on the occurrence of avascular abnormalities.

Adolescent↗
PubMed2004

Disarticulation of the left upper extremity for treatment of giant primary lymphedema--case report.

This unusually rare case of giant primary lymphedema of the left upper extremity in a 21-year old woman, who had undergone five surgical procedures (two Charles' procedures and three partial resections) without lasting clinical improvement, demonstrates the difficulty in achieving satisfactory long-term results in patients with grotesquely huge extremities secondary to primary lymphedema. Disarticulation of the left upper extremity was felt to be the most appropriate surgical option in this severe congenital lymphedema patient.

Adult↗
PubMed2005

[The effect of fibula flap graft on the restoration of the extremities with traumatic compound tissue defects].

OBJECTIVE: To evaluate the clinical effects of fibula flap grafts on the repair of the extremities with traumatic compound tissue defects. METHODS: In 12 cases, the fibula flap grafts were employed to restore the extremities with traumatic compound tissue defects. Of the 12 patients, 9 were males, 3 were females; their ages ranged from 12 to 45. There were 2 cases of tibia defect combined with fibula fracture, 2 cases of tibia defect, 2 cases of radius defect, 3 cases of ulna defect, 1 case of calcaneus defect, and 2 cases of first-metatarsus defect. The bone defect length ranged from 4.2 to 10.6 cm, 7.8 cm in average. The skin defect area ranged from 10.0 cm x 4.5 cm to 27.0 cm x 15.0 cm. The free transplantation of fibular flaps were used in 9 cases, the lapse operation were used in 2 cases, retrograde shift were used in 1 case. RESULTS: Post-operational vein crisis and common peroneal nerve traction injury were observed in category mentioned above respectively. All the 12 fibula flaps survived after proper treatments such as removal of great saphenous vein. Follow-ups were done for 6 to 24 months. Both the transferred fibula and the recipient broken end reflected bones were healed. Four patients underwent the second-phase reconstruction operation of tendon moving power. One wrist and 1 ankle underwent arthrodesis in 3 to 6 months. All the effects were satisfactory. CONCLUSION: The fibula flap grafts provide a relatively better alternative to repair the extremities with long bone compound tissue defects. In addition, the sensory function reconstruction of fibula flaps should be given full attention.

Adolescent↗
PubMed2005

The lower extremity nerve injuries - own experience in surgical treatment.

The frequency of the lower extremity nerve injuries is assessed to about 20% of the overall lesions to the peripheral nerve system. Peroneal neuropathy is the most common lower extremity nerve palsy. In this study, results of the surgical treatment of the lower extremity nerve injuries have been presented. The clinical material consisted of 270 patients (192 males, 78 females aged from 3 months to 74 years) with injuries of the common peroneal nerve - 125, sciatic nerve - 93, common peroneal and tibial nerve - 21, tibial nerve - 17, femoral nerve - 10, others - 4. The following surgical procedures were performed: external neurolysis - 164, internal neurolysis - 27, reconstruction with sural nerve grafting - 63, direct neurorrhaphy - 12, neurotisation - 3, supplementary tenomioplasty - 23. Evaluation of the results with the use of BMRC scale (M0-M5) and Highet scale (S0-S4) included the group of 120 patients. After the surgical treatment a significant improvement was found in 63.3%. The efficacy of the treatment is strictly dependent on an early surgical intervention, mechanism and degree of the nerve injury as well as appropriate method of surgical therapy.

Adolescent↗
PubMed2006

[Application of 16-slice spiral CT in lower extremity arterial occlusive diseases].

OBJECTIVE: To determine the diagnostic accuracy of 16-slice spiral CT in assessing the lower extremity arterial occlusive diseases. METHODS: Thirty patients with suspected peripheral arterial occlusive diseases underwent 16-slice spiral CT angiography (CTA) of lower extremity arteries. All these patients also underwent digital subtraction angiography (DSA) two weeks before or after CTA. CT angiograms were produced using maximal intensity projection, volume rendering technique, and curved planar reconstruction. Using DSA as the standard reference, the diagnostic accuracy of CTA was determined. RESULTS: When detecting segments with > or = 50% stenosis, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of CTA were 94.3% (115/122), 98.4% (548/557), 97.6% (663/679), 92.7% (115/124), and 98.7% (548/555), respectively. CONCLUSION: 16-slice spiral CT has high sensitivity, specificity, and accuracy in detecting lower extremity arterial occlusive diseases and may partially substitute DSA examinations.

Aged↗
PubMed2006

[Prospective investigation of postoperative lower extremity deep venous thrombosis in gynecological procedures].

OBJECTIVE: To investigate the morbidity, relevant factors and diagnostic methods of lower extremity deep venous thrombosis (LEDVT) after gynecological pelvic surgeries. METHODS: A prospective study was carried out investigating the morbidity, characteristics, risk factors, the coagulation function changes and diagnostic methods of LEDVT post-gynecological pelvic operations in 141 cases. Platelet, prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin time, D-dimer, antithrombin-III, tissue plasminogen activator, plasminogen activator inhibitor were measured within 1 week before surgeries, 48 hours and 5 - 7 days post-surgeries respectively. Color Doppler flow imaging was performed simultaneously. RESULTS: (1) Twenty-two cases were found with LEDVT, the morbidity of LEDVT after gynecological procedures was 15.6%. It occurred 2 - 7 days post operation. (2) The risk factors were bedfasting, coagulant prescription post-operation, cardiovascular disease, ageing, pelvic lymphadenectomy, general anesthesia, and malignancy. Multivariate regression showed only age and coagulant prescription post-operation were independent factors. (3) The level of D-dimer was (0.9 +/- 0.6) mg/L in LEDVT group, significantly higher than that of non-LEDVT group [(0.5 +/- 0.4) mg/L, P < 0.01]. The positive predictive value and negative predictive value of D-dimer were 30.8% and 98.6% respectively. (4) Among 22 cases who were diagnosed with LEDVT by compression duplex ultrasound, only 4 cases performed lower extremity venography, and the diagnosis was confirmed. CONCLUSIONS: The morbidity of postoperative lower extremity deep venous thrombosis in gynecological procedures was high. The combination of D-dimer and compression duplex ultrasound examination was applicable to the diagnosis of LEDVT. The optional duration of the examination was 2 - 7 days post operations.

Adult↗
PubMed2006

[Clinical evaluation of eschar grinding and biological dressing A for treatment of deep partial-thickness burn wound on the extremities].

OBJECTIVE: To evaluate the clinical effect of eschar grinding and wound coverage by biological dressing A in the management of deep partial-thickness burn wound on the extremities. METHODS: Seventy-three patients with deep partial-thickness burns on the extremities were divided into two groups to receive different managements. The patients in group 1 were treated with eschar grinding and wound coverage with biological dressing A, and group 2 received conventional treatment. The white blood cell count, body temperature, incidence of wound infection and wound healing time were observed. RESULTS: Compared with conventional treatment, wound management with eschar grinding and coverage by biological dressing A could increase the effective rate (29/32 vs 31/41, P<0.05), inhibit systemic inflammation and scar hypertrophy, and shorten the wound healing time (13.79-/+5.72 vs 17.08-/+8.39, P<0.01). CONCLUSION: Eschar grinding and wound coverage by biological dressing A can be effective for management of deep partial-thickness burns on the extremities, and earlier treatment with the dressing A achieves better effect.

Biological Dressings↗
PubMed2005

[Treatment of acute venous thromboses in patients with varicose disease of lower extremity veins].

The work was devoted to surgical methods of treatment of acute venous thromboses of main lower extremity veins for prevention of thromboembolic complications in patients with varicose disease of lower extremities. Possibilities of surgical correction of the venous blood flow are discussed at different variants of the course of acute venous thrombosis. An analysis of treatment of 92 patients with thrombotic lesions of the main lower extremity veins and high danger of thromboembolic complications has shown that more than 40% of patients with venous thromboembolism need treatment with surgical and medicodiagnostic endovascular interventions. Surgical and endovascular methods of prophylactics of thromboembolism of the lesser circle of blood circulation for complicated forms of chronic venous insufficiency are described.

Female↗
PubMed2006

[Autologous peripheral blood stem cell transplantation for the treatment of lower extremity arterial occlusive disease].

OBJECTIVE: To evaluate the safety and feasibility of autologous peripheral blood mononuclear cells (PBMNCs) implantation after granulocyte-colony stimulating factor (G-CSF)-induced mobilization in patients with lower extremity arterial occlusive disease (AOD). METHODS: A total of 12 patients with AOD were enrolled in this study. Following administration of rhG-CSF (150 microg/d) for 5 days, PBMNCs were harvested and injected intramuscularly in the diseased extremities (3 x 10(9) per limb). RESULTS: One patient received left leg amputation due to uncontrolled ulcer 15 days post PBMNCs transplantation and the symptoms and signs were improved significantly in 9 patients and the symptoms and signs remained unchanged in another 2 aged patients (> 70 years). Doppler ultrasonography measurement showed that peak systolic velocity in diseased extremities was significantly increased post transplantation [(44.55 +/- 4.13) cm/s vs. (21.32 +/- 0.63) cm/s, P < 0.01]. Contrast lower limb angiogram showed increased collateral vessels post transplantation. One aged patient (80 years) who did not respond to autologous PBMNCs received heterologous PBMNCs transplantation (PBMNCs was harvested from a young relative of him) 3 months post autologous PBMNCs transplantation and observed for another 3 months and all observed parameters improved significantly. CONCLUSION: Implantation of autologous PBMNCs collected after G-CSF administration might offer a simple, safe, and effective therapy for the AOD patients.

Aged↗
PubMed2006

Treatment of blast injuries of the extremity.

Blast trauma is a complex event. Pathophysiologically, blast injuries are identified as primary (caused solely by the direct effect of blast overpressure on the tissue), secondary (caused by flying objects or fragments), tertiary (caused by bodily displacement), or quaternary (indirectly caused by the explosion). The range of primary blast injuries includes fractures, amputations, crush injury, burns, cuts, lacerations, acute occlusion of an artery, air embolism-induced injury, compartment syndrome, and others. Secondary injuries are the most common extremity blast injuries. Like primary injuries, they may necessitate limb amputation, be life-threatening, and produce severe contamination. Tertiary blast injuries of the extremity may result in traumatic amputations, fractures, and severe soft-tissue injuries. Quaternary injuries most often are burns. Following treatment and stabilization of immediate life-threatening conditions, all patients are given antibiotic and tetanus prophylaxis. Débridement and wound excision are started as early as possible, with repeat débridement performed as necessary; fasciotomies also are performed to prevent compartment syndrome. Well-vascularized muscular free flaps provide soft-tissue coverage for blast-injured extremities. The closed-open technique of flap closure allows reexamination of the wound, further irrigation, débridement, and later bone and soft-tissue reconstruction.

Blast Injuries↗
PubMed2006

Forequarter amputation of the upper extremity for musculoskeletal tumors: posterior approach revisited.

Forequarter amputation entails surgical removal of entire upper extremity, scapula and clavicle. Several techniques of forequarter amputation have been described. The anterior approach has been the preferred technique of exploration of axillary vessels and brachial plexus. The posterior approach has been condemned to be unreliable and dangerous for most large tumor of the scapula and suprascapular area. We describe a surgical technique using posterior approach of exploration of major vessels for forequarter amputation of upper extremity in eight patients who presented with humeral-scapular tumor. There were six patients with osteosarcoma: three with tumor recurrent and three chemotherapy recalcitrant tumors with vessels involvement. One patient had massive fungating squamous cell carcinoma and another had recurrent rhabdomyosarcoma. Four patients had fungating ulcer and six patients had multiple pulmonary metastases at the time of surgery. The mean estimated blood transfusion was 900 ml (range 0-1600 ml) and two patients did not require transfusion. The duration of surgery ranged 2.5-6.0 hours (mean 3.8 hours). Two patients with known pulmonary metastases required post-operative intensive care monitoring. The mean duration of survival was 5.8 months. The posterior approach of exploring major vessels for forequarter amputation of upper extremity with musculoskeletal tumor is safe and reliable.

Adolescent↗
PubMed2006

Atherosclerosis obliterans of the lower extremities in Thai patients.

BACKGROUND: Major limbs loss and high mortality rate were observed in the management of Thai patients with atherosclerosis obliterans (ASO) of the lower extremities. These were the results of delayed diagnosis and treatment together with the associated morbidities. There is a lack of information of this disease resulting in a lack of knowledge and awareness of this problem among general practitioners in Thailand. OBJECTIVES: The purposes of this study were (1) to identify the prevalence of this disease in a tertiary care hospital, (2) to enumerate the risk factors and comorbidities, (3) to identify clinical characteristics of the disease and (4) to evaluate the outcomes of treatment. MATERIAL AND METHOD: A prospective study ofpatients with ASO of the lower extremities was carried out between January 2000 and December 2004. Patients having clinical manifestations of chronic and acute arterial occlusion with the absence of ankle pulse were included in the present study. Evidence of atheromatous plaque by angiography, operative finding, and histopathology of arterial wall from amputated specimens were used to confirm the diagnosis. The selection of surgical treatments for this disease such as revascularization, major amputation, minor amputation and debridement depended on the severity of limb ischaemia, the status of distal artery and the patients' general condition. The risk factors, comorbidities, clinical manifestations, site of arterial occlusion, severity of ischaemia, types of surgical treatment and outcomes of management were analyzed. RESULTS: Four hundred and fourteen consecutive patients with ASO were diagnosed in the present study with a prevalence of 1.02:1,000. Femoro-popliteal arterial segment was the most common site (221 cases, 53.4%) of the affected arteries. Diabetes mellitus (253 cases, 61. 1%) was the most common risk factor of ASO followed by hypertension (217 cases, 52.4%), smoking (195 cases, 47.1%) and hyperlipidemia (172 cases, 41.5%). Ischaemic heart disease (108 cases, 26.1%) was the most common comorbidity of ASO followed by major stroke (56 cases, 13.5%) and chronic renal failure (20 cases, 4.8%). Patients with ASO presented mostly as chronic manifestations (385 cases, 93%) or with limb-threatening condition (326 cases, 78.7%). The clinical manifestations were ischaemic ulcer and/or digital gangrene (251cases, 60.6%), rest pain (182 cases, 44.0%) incapacitating claudication (62 cases, 15.0%) and acute ischaemic pain (29 cases, 7.0%). One hundred and thirty eight (33.3%) patients had significant lower limb infection at the time of admission. One hundred and seventy one (41.3%) patients underwent revascularization procedures as the major primary treatments to salvage the limbs. The success rate of limb salvage after revascularization was 76.6% (13 1/171). Major amputation after revascularization was 16. 9%(29/ 171). Perioperative mortality rate of revascularization procedure was 8.2 %(14/171). Major amputation was required as the primary treatment due to infective (18.4%, 76/414) and ischaemic process (6.5%, 27/414). The mortality rate of primary major amputation for infection and ischaemia were 19.7%(15/76) and 25.9%(7/2 7) respectively. The total mortality rate in the present study was 11.3% (47/414). The common causes of death were sepsis and ischaemic heart disease. CONCLUSION: ASO of the lower extremities is one of the major problems for national health care causing major limb loss and death. Arterial bypass surgery was the most effective treatment for limb salvage. Management of this disease at the terminal stage causes high morbidity and mortality. Hence, early detection of this disease and correction of the risk factors should be the most effective strategy to improve the overall outcome of the management of this complicated problem.

Adult↗
PubMed1991

Soft tissue sarcomas of the extremity and retroperitoneum: advances in management.

The treatment of soft tissue sarcomas continues to pose significant challenges. The past decade has seen a dramatic increase in multimodality therapy for these tumors, with a resultant decrease in the number of amputations performed for extremity lesions. Even with combined modality treatment, however, the prognosis remains grim for most patients with retroperitoneal sarcomas, in which delay in diagnosis and tumor proximity to vital structures hinder the chances for cure. Improved protocols for the treatment of retroperitoneal sarcomas must be developed if we are to match the successes achieved with extremity tumors. As efforts to decrease local recurrence of extremity sarcomas have been largely successful, a new challenge to decrease the frequency of systemic metastases has emerged. Although aggressive surgical approaches to recurrent and metastatic sarcomas can result in long-term survival in some cases, better treatments are needed for those patients whose resections fail or those who are not candidates for resection. Combined modality treatments and new modalities, such as adoptive immunotherapy, need to be carefully evaluated in this group of patients. Enormous strides have been made in the treatment of osteogenic sarcomas and some pediatric soft tissue sarcomas. Additional research into basic tumor biology, as well as major intergroup studies of therapy, will be necessary if we are to duplicate those achievements in the more refractory adult soft tissue sarcomas.

Combined Modality Therapy↗