scholarly journals Isolated limb perfusion with tumor necrosis factor and melphalan for non-resectable soft tissue sarcomas: Long-term results on efficacy and limb salvage in a selected group of patients

2008 ◽  
Vol 98 (3) ◽  
pp. 148-155 ◽  
Author(s):  
Stéphane Cherix ◽  
Mélanie Speiser ◽  
Maurice Matter ◽  
Wassim Raffoul ◽  
Danièle Liénard ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tumor Necrosis Factor ◽  
Limb Salvage ◽  
Tumor Necrosis ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
Long Term Results ◽  
Limb Perfusion ◽  
Necrosis Factor

scholarly journals Isolated Limb Perfusion with Tumor Necrosis Factor and Melphalan for Limb Salvage in 186 Patients with Locally Advanced Soft Tissue Extremity Sarcomas

1996 ◽  
Vol 224 (6) ◽  
pp. 756-765 ◽  
Author(s):  
Alexander M. M. Eggermont ◽  
Heimen Schraffordt Koops ◽  
Joseph M. Klausner ◽  
Bin B. R. Kroon ◽  
Peter M. Schlag ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tumor Necrosis Factor ◽  
Limb Salvage ◽  
Tumor Necrosis ◽  
Locally Advanced ◽  
Isolated Limb Perfusion ◽  
Limb Perfusion ◽  
Necrosis Factor

Hyperthermic Isolated Limb Perfusion With Tumor Necrosis Factor-? and Melphalan in Advanced Soft-Tissue Sarcomas: Histopathological Considerations

2000 ◽  
Vol 7 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Josephine Issakov ◽  
Ofer Merimsky ◽  
Mordechai Gutman ◽  
Yehuda Kollender ◽  
Dina Lev-Chelouche ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Soft Tissue Sarcomas ◽  
Isolated Limb Perfusion ◽  
Limb Perfusion ◽  
Necrosis Factor

Isolated limb perfusion with high-dose tumor necrosis factor-alpha in combination with interferon-gamma and melphalan for nonresectable extremity soft tissue sarcomas: a multicenter trial.

1996 ◽  
Vol 14 (10) ◽  
pp. 2653-2665 ◽  
Author(s):  
A M Eggermont ◽  
H Schraffordt Koops ◽  
D Liénard ◽  
B B Kroon ◽  
A N van Geel ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tumor Necrosis Factor ◽  
Limb Salvage ◽  
Tumor Necrosis ◽  
Soft Tissue Sarcomas ◽  
Necrosis Factor Alpha ◽  
Limb Perfusion ◽  
Factor Alpha ◽  
Tumor Remnant ◽  
Necrosis Factor

PURPOSE To determine the efficacy of isolated limb perfusion (ILP) with tumor necrosis factor-alpha (TNF) in combination with interferon-gamma (IFN) and melphalan as induction therapy to render tumors resectable and avoid amputation in patients with nonresectable extremity soft tissue sarcomas (STS). PATIENTS AND METHODS Among 55 patients with 30 primary and 25 recurrent sarcomas, there were 48 high-grade and seven grade 1 sarcomas (very large, recurrent, or multiple). The composition of this series of patients is unusual: 13 patients (24%) had multifocal primary sarcomas or multiple recurrent tumors; tumors were very large (median, 18 cm); and nine patients (16%) had known systemic metastases. IFN was administered subcutaneously on the 2 days before ILP with TNF, IFN, and melphalan. A delayed marginal resection of the tumor remnant was usually performed 2 to 3 months after ILP. RESULTS A major tumor response was seen in 87% of patients and rendered the sarcomas resectable in most cases. Clinical response rates were as follows: 10 (18%) completes responses (CRs), 35 (64%) partial responses (PRs), and 10 (18%) no change (NC). Final outcome was defined as follows by clinical and pathologic response: 20 (36%) CRs, 28 (51%) PRs, and seven (13%) NC. Limb salvage was achieved in 84% (follow-up duration, 20+ to 50+ months). In 39 patients, resection of the tumor remnant (n = 31) or of two to eight tumors (n = 8) after ILP was performed; local recurrence developed in five (13%). When no resection was performed (multiple tumors or systemic metastases), local recurrences were frequent (five of 16), but limb salvage was often achieved as patients died of systemic disease. Regional toxicity was limited and systemic toxicity minimal to moderate with no toxic deaths. Histology showed hemorrhagic necrosis; angiographies showed selective destruction of tumor-associated vessels. CONCLUSION ILP with TNF, IFN, and melphalan is a safe and highly effective induction biochemotherapy procedure that can achieve limb salvage in patients with nonresectable extremity STS. TNF is an active anticancer drug in humans in the setting of ILP.

Long-Term Results of Tumor Necrosis Factor α– and Melphalan-Based Isolated Limb Perfusion in Locally Advanced Extremity Soft Tissue Sarcomas

2011 ◽  
Vol 29 (30) ◽  
pp. 4036-4044 ◽  
Author(s):  
Jan P. Deroose ◽  
Alexander M.M. Eggermont ◽  
Albertus N. van Geel ◽  
Jacobus W.A. Burger ◽  
Michael A. den Bakker ◽  
...  
Keyword(s):  
Tumor Necrosis ◽  
Locally Advanced ◽  
Soft Tissue Sarcomas ◽  
Long Term Results ◽  
Limb Salvage Rate ◽  
Limb Perfusion ◽  
Factor Α ◽  
Necrosis Factor ◽  
Salvage Rate

PurposeBecause 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 MethodsWe 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.ResultsThe 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%.ConclusionWe 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.

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