Long-term results of tumor necrosis factor alpha- and melphalan-based isolated limb perfusion in locally advanced extremity soft tissue sarcomas.

Abstract

PURPOSE:

Because there is no survival benefit of amputation for extremity soft tissue sarcomas (STSs), limb-sparing surgery has become the gold standard. Tumor size reduction by induction therapy to render nonresectable tumors resectable or facilitate function-preserving surgery can be achieved by tumor necrosis factor α (TNF) -based and melphalan-based isolated limb perfusion (TM-ILP). This study reports the long-term results of 231 TM-ILPs for locally advanced extremity STS.

PATIENTS AND METHODS:

We analyzed 231 TM-ILPs in 208 consecutive patients (1991 to 2005), who were all candidates for functional or anatomic amputation for locally advanced extremity STS. All patients had a potential follow-up of up to 5 years. TM-ILP was performed under mild hyperthermic conditions with 1 to 4 mg of TNF and 10 to 13 mg/L of limb-volume melphalan. Almost all patients (85%) had intermediate- or high-grade tumors.

RESULTS:

The overall response rate (ORR) was 71% (complete response, 18%; partial response, 53%). Multifocal sarcomas had a significantly better ORR of 83% (P = .008). The local recurrence rate was 30% (n = 70); local recurrence rates were highest for multifocal tumors (54%; P = .001) and after previous radiotherapy (54%; P < .001). Five-year overall survival rate was 42%. Survival was poorest in patients with large tumors (P = .01) and with leiomyosarcomas (P < .001). Limb salvage rate was 81%.

CONCLUSION:

We demonstrated that TM-ILP results in a limb salvage rate of 81% in patients with locally advanced extremity STS who would otherwise have undergone amputation. Whenever an amputation is deemed necessary to obtain local control of an extremity STS, TM-ILP should be considered.

• Authors: Jan P Deroose, Alexander M M Eggermont, Albertus N van Geel, Jacobus W A Burger, Michael A den Bakker, Johannes H W de Wilt, Cornelis Verhoef
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 29 Issue 30 Pg. 4036-44 (Oct 20 2011) ISSN: 1527-7755 [Electronic] United States
• PMID: 21931039 (Publication Type: Journal Article)

Chemical References

• Recombinant Proteins
• Tumor Necrosis Factor-alpha
• Melphalan

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Chemotherapy, Cancer, Regional Perfusion (adverse effects, methods)
• Child
• Combined Modality Therapy
• Disease-Free Survival
• Extremities
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Male
• Melphalan (administration & dosage, adverse effects)
• Middle Aged
• Recombinant Proteins (administration & dosage)
• Sarcoma (drug therapy)
• Soft Tissue Neoplasms (drug therapy)
• Tumor Necrosis Factor-alpha (administration & dosage, adverse effects)
• Young Adult