Tumor necrosis factor-α, melphalan-based isolated limb perfusion benefits amputation candidates
WEDNESDAY, Sept. 21 (HealthDay News) -- Tumor necrosis factor-α (TNF) and melphalan-based isolated limb perfusion (TM-ILP) therapy has a limb salvage rate of 81 percent in patients with locally advanced extremity soft tissue sarcomas (STSs) who would have otherwise undergone amputation, according to a study published online Sept. 19 in the Journal of Clinical Oncology.
Jan P. Deroose M.D., from the Erasmus Medical Center in Rotterdam, Netherlands, and colleagues assessed the long-term results of 231 TM-ILPs in 208 patients who were candidates for functional or anatomic amputation for locally advanced extremity STS. Nearly 85 percent of the patients had intermediate- or high-grade tumors. All underwent TM-ILP under mild hyperthermic conditions, with 1 to 4 mg of TNF and 10 to 13 mg/L of limb-volume melphalan, and were followed for up to five years.
The investigators found that the overall response rate (ORR) was 71 percent (complete and partial response, 18 and 53 percent, respectively). Multifocal sarcomas were associated with a significantly higher ORR of 83 percent. The local recurrence rate was 30 percent and was highest after previous radiotherapy and for multifocal tumors (54 percent each). The overall five-year survival rate was 42 percent and was lowest in patients with leiomyosarcomas and large tumors. The rate of limb salvage was 81 percent.
"Whenever an amputation is deemed necessary to obtain local control of an extremity STS, TM-ILP should be considered," the authors write.
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