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The palliative value of tumor necrosis factor α-based isolated limb perfusion in patients with metastatic sarcoma and melanoma
Version of Record online: 1 DEC 2005
Copyright © 2005 American Cancer Society
Volume 106, Issue 1, pages 156–162, 1 January 2006
How to Cite
Grunhagen, D. J., de Wilt, J. H. W., Graveland, W. J., van Geel, A. N. and Eggermont, A. M. M. (2006), The palliative value of tumor necrosis factor α-based isolated limb perfusion in patients with metastatic sarcoma and melanoma. Cancer, 106: 156–162. doi: 10.1002/cncr.21547
- Issue online: 23 DEC 2005
- Version of Record online: 1 DEC 2005
- Manuscript Accepted: 19 JUL 2005
- Manuscript Revised: 4 JUL 2005
- Manuscript Received: 31 JAN 2005
- isolated limb perfusion;
- soft tissue sarcoma;
- tumor necrosis factor α
Both patients with soft tissue sarcoma (STS) and patients with melanoma have limited treatment possibilities once the tumor has metastasized systemically. In patients with extremity STS or bulky melanoma in-transit metastases, the local tumor burden may be so problematic that, even in patients with systemically metastasized disease, an amputation may be inevitable. Isolated limb perfusion (ILP) has proven to be an excellent, local, limb-saving treatment option in patients with locally advanced extremity tumors. In this study, the authors investigated the palliative value of the ILP procedure to avoid amputation in patients who had Stage IV STS and melanoma.
From 1991 to 2003, of 339 tumor necrosis factor α (TNF)-based ILPs, 51 procedures were performed for either Stage IV STS (n = 37 patients) or Stage IV melanoma (n = 14 patients). All patients underwent an ILP with TNF and melphalan of the upper limb (n = 4 patients) or the lower limb (n = 47 patients) with 26–140 mg melphalan and 2–4 mg TNF.
The overall response in patients with Stage IV STS was 84%, and their median survival was 12 months after ILP. Limb salvage was achieved in 36 of 37 patients, with 1 patient undergoing amputation due to treatment toxicity. In the patients with Stage IV melanoma, the complete response rate was 43%. All patients with melanoma preserved their limb during a median survival of 7 months.
TNF-based ILP is an excellent procedure that provided tumor control and limb salvage for the short survival of patients with metastasized, very bulky, limb-threatening tumors of the extremity. Cancer 2006. © 2005 American Cancer Society.