15 YEARS EXPERIENCE WITH ISOLATED LIMB PERFUSION, A LIMB SALVAGE STRATEGY FOR NON-RESECTABLE SOFT TISSUE SARCOMAS OF THE EXTREMITIES.

Abstract

Introduction: Isolated limb perfusion (ILP) is the local infusion of high doses of TNF and Melphalan, a potent chemotherapeutic agent, under controlled hyperthermia (< 40°). ILP may be used as an exclusive limb salvage procedure or as a neo-adjuvant treatment.

Material & method: Retrospective study in a tertiary centre with a multidisciplinary approach.

Results: Since 1992, 51 patients (mean age 54,8) 27 women, 24 men, with an non-resectable soft tissue sarcoma of an extremity (44 lower limb, 7 upper limb), have been treated by ILP, followed by surgical resection in 34 (65%). 6 patients had a 2nd ILP after local recurrence or ongrowing unresected tumor.

They have been evaluated after a mean follow-up of 3,6 years (13 months–15 years).

Five patients had grade I sarcoma, 17 grade II, 28 grade III and 1 unstated (FNCLCC classification). All but 5 presented a localised disease at the time of diagnosis. The reason for ILP was extracompartimental location in 10, contiguity to nervous or vascular structures in 10, the size of the lesion alone for 10 (up to 28 cm), and local spread of the tumor at presentation or by former surgical procedures 21. Thirteen patients presented major or longlasting post-operative complications, mostly cutaneous and neurological. Twenty-five percent of patients had a complete response to treatment, 44% a partial response, 17% no change and the remaining 14% a progressive disease. Ten radical (R0), 20 marginal (R1) and 4 intralesional (R2) resections have been performed 5,3 months (1,5–42) after ILP. Seven patients had a primary amputation (14%) and 10 had no operation or refused it. A reconstructive surgery was performed in 32% of the patients, and 27% had a complmentary radio- and/or chemotherapy. With a mean follow-up of 3,6 years (13 months–15 years), 33% patients were free of recurrence, 13% had local recurrence only, 27% distant only, and 27% both local and distant. From the 19 patients (40%) with local recurrence, 12 needed at least one new operation, with 5 more amputations.

Overall time to distant recurrence is 27,9 months (2–43), and to local recurrence is 22,3 months (2–78) respectively. Two and 5 years survival are 60,3% and 43,5% respectively.

Conclusion: As 24% of the patients were finally amputated, a 76% limb salvage was observed for tumours that were initially non-resectable.