Guidelines for Complications of Cancer Treatment Vol VIII Part B

involvement in four of the 20 patients. In three of these fourpatients, IVUS confirmed resectability and demonstrated atissue layer between tumour and vessels. In only one patientdid IVUS disclose infiltration of the popliteal artery, whichappeared displaced but not involved by tumour on MRI. Themajor advantage of IVUS was its ability to confirm the absenceof vascular involvement in several patients, thereby avoidingunnecessary resection of major vessels. The authors point outthat although high-resolution ultrasonography can evaluatedirect vascular infiltration, it is often impossible to visualizeremote tumour sites owing to the limited field of view of thetransducer. MRI therefore remains indispensable for accuratevisualization of large and bulky tumours and a combinationof MRI and IVUS may improve assessment of resectability ofsoft tissue sarcoma in close proximity to major vessels. Otherdisadvantages of IVUS include the learning curve and the costsof additional technical equipment.Surgical ManagementMost of the time tumors juxtaposed to vessels withoutencasement are resectable by excising the tumor along withthe vascular adventitia, provided that an effective adjuvant isused (radiotherapy for soft tissue sarcomas or chemotherapyfor osteosarcoma) or the tumor was of low histologic grade.In these cases, the goal of the surgery is to obtain wide orwide with focally marginal surgical margins. If adequatemargins are not obtainable, a vascular resection andreconstruction or an amputation is necessary. Data gatheredfrom literature 3,6-9 indicates that patients can avoid amputation,despite malignant involvement of major vessels to theirextremities. Though the complication rate observed in thissubset of patients is significant, local control and the incidenceof major complications is acceptable. Although only a fewseries are reported in literature, most have shown that for vesselinvolvement, a resection and reconstruction of the vessels is146