Oncosurgery Limbs

Soft tissue Sarcoma and Bone Tumors

Q1) Soft tissue Sarcoma  with pulmonary metastasis ?? Which of the following is least likely to  affect treatment.
a) Histology of primary.

b)  Disease free interval
c)  Number of nodules.
d) Positive Surgical margins

Ans d - ALL are correct least likely would be d

Isolated pulmonary metastases occur in as many as 20% of patients diagnosed with soft tissue sarcoma as many as 40% in those with a primary bone sarcoma

Prognostic factors characterized include the

a) histology of the primary sarcoma

b)) disease-free interval (DFI),

c) number of lesions in the lung,

d) Surgeon’s ability to obtain a complete resection,

e) The responsiveness to chemotherapy

f) and lymph node status.

Q2) Which of the following soft tissue sarcoma  (STS) associated with least lymph node metastasis:-
A. Fibrosarcoma
C. Epitheloid sarcoma
D. Rhabdomyosarcoma

Q3 ) Round cell tumor in the fibula? WHat is the diagnosis and management

a) Osteosarcoma & surgery

b) Osteosarcoma & chemotherapy

c) Ewing Sarcoma & cheomo 

d) Ewing and surgery

Ans c) Ewing sarcoma & Chemo  initially

Ewing sarcoma and primitive neuroectodermal tumor are small blue cell (microscopic appearance) malignancies of bone that cytogenetically represent the same entity.

Sabiston page 765

The most common presentation of bone sarcomas (Ewing sarcoma or osteosarcoma) is pain or swelling in a bone or joint. Ewing sarcoma may involve flat bones or the diaphysis of tubular bones such as the femur, pelvis, tibia, and fibula. Ewing sarcoma may also occur in soft tissues.

Chemotherapy has revolutionized the treatment of most bone sarcomas
and is considered standard care for osteosarcoma and Ewing sarcoma.

Anderson 270

Q) False about isolated limb perfusion in Soft tissue sarcoma (AIIMS onco 2021) 

a) MELPHALAN with hyperthermia is most effective 

b) Real time drug assay to monitor drug leak

c) Soft tissue fibrosis or, necrosis can occur

d) Used for recurrent melanoma with in transit metastasis


Ans a ) Fraker et al. reported a 100% response rate in patients treated with melphalan alone and a 90% response rate in patients treated with
melphalan, IFN-γ, and TNF-α, although the latter combination resulted in
a higher complete response rate (80% vs. 61%).

A multicenter randomized trial sponsored by the American College of Surgeons Oncology Group comparing melphalan alone with a combination of melphalan and TNF-α for patients who have in-transit metastases was closed to accrual early
because an interim analysis failed to reveal a benefit for TNF-α.

Isolated Limb Perfusion. Perfusion of limbs requires isolating the arterial and venous system of the limb by means of a tourniquet and obtaining access to arteries and veins that supply the limb.

2. To ensure that there is no leakage of the circuit into the systemic circulation; technetium-labeled albumin is injected into the circuit, and a probe is used over the heart to ensure isolation of the bypass circuit.

3.. hyperthermia may make chemotherapy more effective in some clinical settings, the blood of the circuit is often warmed to 39°C to 40°C.

4. Complications of this technique include shock (from systemic leak of TNF); infection; chronic damage to skin, muscles, and nerve; persistent edema; and
arterial or venous thrombosis.

6. Hyperthermic isolated limb perfusion (HILP) with melphalan has been used to treat in-transit metastases of the extremities

Ref Devita below table 90.3

Anderson page 179