The growth rate of bone sarcomas and survival after radiotherapy with tourniquet-induced hypoxia: a clinical study.

The volume doubling time of primary bone sarcomas and lung metastases was determined by measurements made on serial radiographs. For the primary tumors, the volume doubling times were log-normally distributed and varied in the range of 20--200 days with a mean around 50 days. The volume doubling times of the metastases also showed a log-normal distribution in the range of 10--100 days, but with a mean twice as short as that of the primates. Radiation therapy was given with three--four doses of 20--25 Gy to the tumors that, together with the surrounding normal tissues, had been made hypoxic by the application of a tourniquet. Amputations were not performed unless required eventually by some serious late radiation damage, such as grave functional deficiency, and/or painful fibrosis and ankyloses. In no case did microscopic examination of the amputated tissues reveal the persistence of any viable, neoplastic cells. The five-year survival of a total of 69 patients was 26%. Survival expectancy was found to be closely related to the volume doubling time of the tumors, as was the incidence of the metastases. The data stress the importance of volume doubling time as a predictive factor and indicate, furthermore, that treatment with a few massive radiation doses in combination with tourniquet-induced hypoxia is effective in the local control of bone sarcomas. The several late reaction of the normal tissues to the treatment will, however, require amputations in most of the five-year survivors.