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Outcome and prognostic factor analysis of 217 consecutive isolated limb perfusions with tumor necrosis factor-α and melphalan for limb-threatening soft tissue sarcoma
Article first published online: 15 MAR 2006
Copyright © 2006 American Cancer Society
Volume 106, Issue 8, pages 1776–1784, 15 April 2006
How to Cite
Grunhagen, D. J., de Wilt, J. H. W., Graveland, W. J., Verhoef, C., van Geel, A. N. and Eggermont, A. M. M. (2006), Outcome and prognostic factor analysis of 217 consecutive isolated limb perfusions with tumor necrosis factor-α and melphalan for limb-threatening soft tissue sarcoma. Cancer, 106: 1776–1784. doi: 10.1002/cncr.21802
- Issue published online: 4 APR 2006
- Article first published online: 15 MAR 2006
- Manuscript Accepted: 7 NOV 2005
- Manuscript Revised: 13 OCT 2005
- Manuscript Received: 14 JUN 2005
- isolated limb perfusion;
- soft tissue sarcoma;
Extensive and mutilating surgery is often required for locally advanced soft tissue sarcoma (STS) of the limb. As it has become apparent that amputation for STS does not improve survival rates, the interest in limb-preserving approaches has increased. Isolated limb perfusion (ILP) with tumor necrosis factor-α (TNF) and melphalan is successful in providing local tumor control and enables limb-preserving surgery in a majority of cases. A mature, large, single-institution experience with 217 consecutive ILPs for STS of the extremity is reported.
At a prospectively maintained database at a tertiary referral center, 217 ILPs were performed from July 1991 to July 2003 in 197 patients with locally advanced STS of the extremity. ILPs were performed at mild hyperthermic conditions with 1–4 mg of TNF and 10–13 mg/L limb-volume melphalan (M) for leg and arm perfusions, respectively.
The overall response rate was 75%. Limb salvage was achieved in 87% of the perfused limbs. Median survival post-ILP was 57 months and prognostic factors for survival were Trojani grade of the tumor and ILP for single versus multiple STS. The procedure could be performed safely, with a perioperative mortality of 0.5% in all patients with no age limit (median age, 54 yrs; range, 12–91). Systemic and locoregional toxicity were modest and easily manageable.
TNF+M-based ILP can provide limb salvage in a significant percentage of patients with locally advanced STS and has therefore gained a permanent place in the multimodality treatment of STS. Cancer 2006. © 2006 American Cancer Society.