Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: Systematic review of clinical efficacy and quality assessment of reported trials
Article first published online: 17 JUL 2012
Copyright © 2012 Wiley Periodicals, Inc.
Journal of Surgical Oncology
Volume 106, Issue 8, pages 921–928, December 2012
How to Cite
Trabulsi, N.H., Patakfalvi, L., Nassif, M.O., Turcotte, R.E., Nichols, A. and Meguerditchian, A.N. (2012), Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: Systematic review of clinical efficacy and quality assessment of reported trials. J. Surg. Oncol., 106: 921–928. doi: 10.1002/jso.23200
- Issue published online: 14 NOV 2012
- Article first published online: 17 JUL 2012
- Manuscript Accepted: 29 MAY 2012
- Manuscript Received: 5 JAN 2012
- Cedars Cancer Institute (Montreal, Canada)
- regional chemotherapy;
- advanced disease
Background and Objectives
Extremity soft tissue sarcomas (STS) are managed with radiotherapy and limb-sparing surgery however aggressive or recurrent cases require amputation. Hyperthermic isolated limb perfusion (HILP) has been proposed as an alternative. Our aim was to systematically review phase II HILP trials, assess tumor response, limb salvage (LS), and quality of scientific publications on this technique.
We conducted a literature search of electronic databases (MEDLINE, EMBASE, Scopus, Cochrane Library) and clinical trial registries for phase II HILP trials on non-resectable extremity STS. Outcomes of interest were complete response (CR), partial response (PR), and LS rates. Quality of published trials was assessed using a quality checklist.
Of 518 patients across 12 studies, 408 had some response (CR or PR), and 428 had the limb spared. Median CR, PR, and LS rates were 31%, 53.5%, and 82.5%, respectively. Median Wieberdink loco-regional toxicity rates were 3.8%, 45.5%, 17%, 1%, and 0% for levels 1–5, respectively. No trial fulfilled either all ideal or essential quality criteria. Seven trials did not include statistical methodology.
HILP seems effective in treating advanced extremity STS. However, poor publication quality hinders results validity. Technical and methodological standardization, well-designed, multi-institutional trials are warranted. J. Surg. Oncol. 2012; 106: 921–928. © 2012 Wiley Periodicals, Inc.