title: Treatment of recurrent sarcoma of the extremities by isolated limb perfusion using tumor necrosis factor alpha and melphalan.
abstract: BACKGROUND
  24-60% of patients with soft tissue sarcoma shows local recurrences after treatment of the primary tumor. The event is associated with a high incidence of macroscopic or microscopic metastases and a poor survival. Our goal is to preserve a patient's functional limb by treating such cases with isolated limb perfusion (ILP) with recombinant human tumor necrosis factor alpha (rHu TNF-alpha) and melphalan, which have demonstrated a potent antitumor activity in vivo and in vitro studies.
  
  
  METHODS
  During the period November 1991 to November 1995, 10 patients with unresectable recurrent soft tissue sarcoma of the limb were treated by ILP at intermediate hyperthermia (40-40.5 degrees C) with rHu TNF-alpha and melphalan. Two patients also received recombinant interferon gamma (rIFN-gamma) before and during ILP. We used a range of 2-4 mg for rHu TNF-alpha and 50-100 mg of melphalan. rIFN-gamma was administered on days -2 and -1 (15 x 10(6) IU) subcutaneously and the same dose was injected in the arterial line during ILP.
  
  
  RESULTS
  No perioperative surgical complication was observed. Local toxicity was moderate (grade I or II); general toxicity was observed in 6 patients (2 grade I and 4 grade III). Complete response was obtained in 7 cases; 2 patients had a partial response and finally 1 was a nonresponder and showed local progression, which required surgical amputation. Tumor necrosis (observed in 5 cases) was maximal in 4 patients (80-100%) and absent in the patient who had local progression.
  
  
  CONCLUSIONS
  The results we obtained with the treatment of soft tissue sarcoma confirm the efficacy of ILP as a limb-sparing methodology for unresectable recurrences. Furthermore, rHu TNF-alpha and melphalan confirmed their antitumor activity when associated with hyperthermia. Amputation or disarticulation may be reliable as a second-choice treatment for these patients.
authors.affiliation: Division of Surgical Oncology B, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Santinami
authors.forename: M
authors.initials: M
authors.lastname: Deraco
authors.forename: A
authors.initials: A
authors.lastname: Azzarelli
authors.forename: F
authors.initials: F
authors.lastname: Cascinelli
authors.forename: A
authors.initials: A
authors.lastname: Chiti
authors.forename: V
authors.initials: V
authors.lastname: Costagli
authors.forename: M G
authors.initials: MG
authors.lastname: Inglese
authors.forename: R
authors.initials: R
authors.lastname: Manzi
authors.forename: V
authors.initials: V
authors.lastname: Quagliolo
authors.forename: G
authors.initials: G
authors.lastname: Rebuffoni
authors.forename: N
authors.initials: N
authors.lastname: Santoro
authors.forename: M
authors.initials: M
authors.lastname: Vaglini
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001132:Arm; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007866:Leg; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010477:Perfusion / Q000379:methods; D012509:Sarcoma / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan