Isolated limb perfusion for soft tissue sarcoma: Current practices and future directions. A survey of experts and a review of literature. (August 2020)

• Record Type: Journal Article
• Authors: Martin-Tellez, K.S.; van Houdt, W.J.; van Coevorden, F.; Colombo, C.; Fiore, M.
• Is Part Of: Cancer treatment reviews. Volume 88(2020)
• Publication Date: 2020-08
• Subjects: Isolated limb perfusion -- Soft tissue sarcomas -- TNFα; Cancer -- Periodicals; Cancer -- Treatment -- Periodicals; Neoplasms -- therapy -- Periodicals; Cancer -- Périodiques; Cancer -- Traitement -- Périodiques; Cancer -- Treatment; Electronic journals; Periodicals; 616.99406
• DOI: 10.1016/j.ctrv.2020.102058
• Languages: English
• ISSNs: 0305-7372

Abstract

Highlights: ILP may be an effective treatment for limb preservations in ESTS. The combination of melphalan and TNFα is the standard drug regimen for sarcoma. Limb preservation rates from 72 to 96%; overall response rates from 72 to 82.5%. Innovating agents might allow for better patient selection and outcome. Great variation in technique among centers that should be addressed. Abstract: Soft tissue sarcomas constitute 1% of adult malignant tumors. They are a heterogeneous group of more than 50 different histologic types. Isolated limb perfusion is an established treatment strategy for locally advanced sarcomas. Since its adoption for sarcomas in 1992, after the addition of TNFα, few modifications have been done and although indications for the procedure are essentially the same across centers, technical details vary widely. The procedures mainly involves a 60 min perfusion with melphalan and TNFα under mild hyperthermia, achieving a limb preservation rate of 72–96%; with an overall response rates from 72 to 82.5% and an acceptable toxicity according to the Wieberdink scale. The local failure rate is 27% after a median follow up of 14–31 months compared to 40% of distant recurrences after a follow up of 12–22 months. Currently there is no consensus regarding the benefit of ILP per histotype, and the value of addition of radiotherapy or systemic treatment. Further developments towards individualized treatments will provide a better understanding of the population that can derive maximum benefit of ILP with the least morbidity.