New concept of limb salvage surgery in musculoskeletal sarcomas with acridine orange therapy

Although limb salvage surgery involving wide resection and limb reconstruction for musculoskeletal sarcomas is well established for low risk of local tumor recurrence, limb function is unsatisfactory for many patients because of the disability in active athletics such as running, jumping, throwing, swimming etc. To avoid poor limb function caused by surgery, it is important to preserve normal nerves, vessels, bones, joints and muscles adjacent to tumor as possible as we can, supported by effective adjuvant therapy to inhibit local tumor recurrence. To develop minimally-invasive limb salvage surgery with minimal damage of normal tissues and low risk of local recurrence, we have recently established a new limb salvage modality of acridine orange (AO) therapy (AOT) based on photodynamic surgery (PDS), photodynamic therapy (PDT) and radiodynamic therapy (RDT) using AO in patients with high-grade malignant musculoskeletal sarcoma. Clinical outcomes of the study showed that: 1) low risk of local recurrence which is almost the same as that with conventional wide resection, and 2) superior limb function to that by wide resection. In this chapter, we present mechanisms of cytocidal effects of AOT based on experimental research and clinical outcome of AOT applied to musculoskeletal sarcoma patients. © 2012 by Nova Science Publishers, Inc. All Rights Reserved.