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Advanced Extremity Soft Tissue Sarcoma: Prognostic Effect of Isolated Limb Perfusion in a Series of 88 Patients Treated at a Single Institution

¹ Department of Surgery, Istituto Nazionale per lo studio e la cura dei Tumori, via Venezian, 1, 20133 Milan, Italy
² Department of Biostatistics, Istituto Nazionale per lo studio e la cura dei Tumori, Milan, Italy
³ Department of Pathology, Istituto Nazionale per lo studio e la cura dei Tumori, Milan, Italy
⁴ Department of Diagnostic Imaging and Radiotherapy, Istituto Nazionale per lo studio e la cura dei Tumori, Milan, Italy
⁵ Department of Cancer Medicine, Istituto Nazionale per lo studio e la cura dei Tumori, Milan, Italy

Correspondence: Address correspondence and reprint requests to: Alessandro Gronchi, MD; E-mail: alessandro.gronchi{at}istitutotumori.mi.it

Purpose: To explore the prognostic impact of isolated limb perfusion (ILP) in locally advanced extremity soft tissue sarcomas (ESTS).

Methods: From August 1982 to April 2005, 1,119 patients affected by ESTS (girdle excluded) were observed and treated at our institution. Eighty-eight (7.9%) were judged non-resectable or locally advanced and underwent ILP. Thirty-seven patients received antiblastic alone (non-TNF-ILP) while 51 had anti-blastic + recombinant-tumor necrosis factor alpha (TNF-ILP). Local disease-free survival (LDFS) was calculated by the Kaplan–Maier method and was reported separately in the two subgroups.

Results: Limb salvage was achieved in 83% (73/88) of the patients. The observed overall (complete + partial) response rate was 59%. In the TNF-ILP group a complete response (CR) was achieved in 21 (41%) patients, while in the non-TNF ILP group a CR was obtained in seven (19%) cases (P < 0.05). Patients with in-transit metastases (epithelioid sarcomas and clear cell sarcomas) had a significantly worse long-term outcome (LDFS at 5 years was 40.9 vs 67.3%, P < 0.05). A trend towards a better LDFS at 5 years could be observed in the patients receiving TNF (63.6 vs 57.1%) and post-operative radiation therapy (RT) (79.3 vs 55.4%).

Conclusions: Isolated limb perfusion is an active treatment. By adding TNF a better local control seems to be obtained, possibly due to a higher rate of CR. It should therefore be considered as a valid option for patients affected by limb-threatening STS, save for in-transit metastases from epithelioid and clear cell sarcoma. Post-operative RT should always be considered.

Key Words: Sarcoma • Limb • Isolated limb perfusion • TNF- • Surgery • Prognosis

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