High-grade
sarcomas have a high rate of local recurrence as well as distant
metastases. This has led to the development of intra-arterial
chemotherapy (IAC) as part of a multimodal approach to control local disease and/or reduce the extent of surgical resection. Intra-arterial
catheters are positioned by an interventional radiologist into the feeding vessels of the
tumor.
Adriamycin and
5-fluorodeoxyuridine are infused intra-arterially. Cisplatinum, with or without
granulocyte colony stimulating factor, is given systemically. Patients usually experience acute self-limited soft-tissue
inflammation in the treated area. In our experience of 118 patients, 3 patients experienced soft-tissue
necrosis that required excision and reconstruction. The first was treated for
synovial sarcoma of a metatarsal. After IAC with
Adriamycin, she sloughed the skin, subcutaneous tissue, and some of the posterior compartment musculature of her calf. This tissue was debrided. A gastrocnemius flap and skin graft were used for coverage. She is free of disease and ambulatory. The second patient was treated with IAC
Adriamycin for a radial head
chondrosarcoma. She developed soft-tissue slough, which became infected with Pseudomonas. She required extensive
debridement of the skin, subcutaneous tissue, and muscle, and was subsequently reconstructed with a latissimus flap and a split-thickness skin graft (STSG). She later developed a local recurrence requiring
amputation. The latissimus was elevated and used to cover the distal stump. She also is free of disease. The third patient was treated with IAC
Adriamycin for
Ewing's sarcoma of the right femur. This was complicated by
fat necrosis and persistent
pain. Subsequent
radiotherapy only worsened her symptoms. She underwent wide excision and muscle flap/STSG repair, which relieved her
pain. She is currently ambulatory and free of disease. In conclusion, as the use of IAC continues, its complications may become more common. Our experience with this previously unknown entity is illustrated and therapeutic options are discussed.