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Tumor vascularization and histopathologic regression of soft tissue sarcomas treated with isolated limb perfusion with TNF-α and melphalan

Authors

  • Florian Grabellus MD,

    Corresponding author
    1. Institute of Pathology and Neuropathology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
    • Institute of Pathology and Neuropathology, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. Fax: +49-201-7235926.===

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  • Corinna Kraft,

    1. Institute of Pathology and Neuropathology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Sien-Yi Sheu-Grabellus MD,

    1. Institute of Pathology and Neuropathology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Sebastian Bauer MD,

    1. Department of Internal Medicine (Cancer Research), Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Lars E. Podleska MD,

    1. Department of Trauma Surgery, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Thomas C. Lauenstein MD,

    1. Department of Diagnostic and Interventional Radiology and Neuroradiology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Christoph Pöttgen MD,

    1. Department of Radiotherapy, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Margarethe J. Konik,

    1. Institute of Pathology and Neuropathology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Kurt W. Schmid MD,

    1. Institute of Pathology and Neuropathology, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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  • Georg Taeger MD

    1. Department of Trauma Surgery, Sarcoma Center, West German Cancer Center, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Abstract

Background

Isolated limb perfusion (TM-ILP) achieves high response rates in soft tissue sarcomas (STS). Some tumors show an insufficient association between radiological and pathological response. We investigated STS after TM-ILP with a primary emphasis on histologic regression patterns.

Methods

In 53 patients with STS, TM-ILP with subsequent tumor resection was performed. Regression was assessed by the Salzer-Kuntschik regression scale. Microvessel density (MVD) of primary biopsies of 37 patients was determined by immunohistochemistry. Tumor regression was correlated with MVD of primary biopsies and other clinico-pathological parameters.

Results

Regression presented mainly as necrosis or fibrosis/sclerosis upon histopathology. MFH, leiomyosarcoma, or clear cell sarcoma (CCS) responded well; whereas liposarcomas, synovial sarcomas, or MPNST were poor responders. MFH often had abundant necrosis; while other STS mainly presented with fibrosis/sclerosis. MVD had no influence on regression grade but modulated histologic regression patterns. Excellent regression demonstrated a trend toward an association with improved survival and local control.

Conclusion

TM-ILP yielded high response rates in STS. Regression after TM-ILP exhibits MVD-dependent histopathologic patterns and variable efficacy in different sarcoma types. Complete regression seems to be a favorable prognostic factor. A concerted consideration of histopathology and clinical findings may contribute to a better clinical assessment of regression after TM-ILP. J. Surg. Oncol. 2011; 103:371–379. © 2011 Wiley-Liss, Inc.

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