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
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
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DOI：
10.1002/jso.21081
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发表时间：
2008-09-01
影响因子：
2.5
通讯作者：
Leyvraz, Pierre-Francois
中科院分区：
文献类型：
--
作者：
Cherix, Stephane;Speiser, Melanie;Leyvraz, Pierre-Francois
背景和目标：TNF-α和美法仑（TM-ILP）的隔离肢体灌注是四肢不可切除软组织肉瘤（STS）的保肢治疗。它适用于截肢或衰弱手术是唯一选择的患者。它既可以作为一种独家治疗，方法：1992年2月至2006年3月，对51例患者进行了57例TM-ILP，其中88%为高级别肿瘤，84%为晚期肿瘤。平均随访时间为38.9个月（4-159个月，中位数22个月）。21%的患者有严重的早期并发症，3例重大再手术，23%的患者有长期并发症。完全缓解率为25%，部分缓解率为42%，疾病稳定率为14%，疾病进展率为14%。65%的患者可以切除肿瘤残留物。31%的患者需要补充治疗，主要是放射治疗。局部复发率为35%，平均20.3个月（2-78），远处复发率为45%，平均13.4个月（5-196）。平均无病生存期为14.9个月，总5年生存率为43.5%。结论：TM-ILP是一种保守治疗方法，并发症发生率高，但即使是最严重的肢体STS也能获得成功。因此，约75%的患者的肢体可以长期免于截肢或衰弱手术。
Background and Objectives: Isolated limb perfusion with TNF-alpha and melphalan (TM-ILP) is a limb salvage therapy for non-resectable soft tissue sarcomas (STS) of the extremities. It is indicated for patients for whom amputation or debilitating surgery is the only alternative. It can be used either as an exclusive therapy (in palliation) or as a neo-adjuvant treatment, followed by marginal resection of tumor remnants with minimal functional impairment.Methods: Between February 1992 and March 2006, 57 TM-ILPs were performed on 51 patients with 88% high grade and 84% advanced stage tumors.Results: Mean follow-up is 38.9 months (4-159, median 22 months). Twenty-one percent patients had significant early complications, with 3 major re-operations, and 23% suffered long-lasting complications. Complete response was observed in 25%, partial response in 42%, stable disease in 14% and progressive disease in 14%. Resection of the tumor remnants was possible in 65%. A complementary treatment was necessary in 31%, mostly radiation therapy. A local recurrence was observed in 35%, after a mean of 20.3 months (2-78), and distant relapse was seen in 45%, after a mean of 13.4 months (5-196). Mean Disease-free survival was 14.9 months, and overall 5-year-survival 43.5%. Amputation rate at 5 years was 24%.Conclusions: TM-ILP is a conservative treatment with a high complications rate, but it can be successful even for the most severe STS of extremities. As a consequence the limb can be spared from amputation or debilitating surgery on the long term in about 75% of patients.