title: Isolated limb perfusion with tumour necrosis factor-alpha and melphalan for unresectable bone sarcomas of the lower extremity.
abstract: OBJECTIVE
  Isolated limb perfusion (ILP) with recombinant tumour necrosis factor-alpha (rTNF-alpha) and melphalan has recently been reported to induce major tumour responses and permit limb salvage in over 80% of patients with unresectable soft-tissue sarcomas of the extremities. We investigated whether TNF-based ILP could allow limb-sparing surgery in patients with primary, recurrent or metastatic bone sarcoma to the lower extremity who met the criteria for an amputation and had failed or refused chemotherapy.
  
  
  METHODS
  From August 1992 to December 1997, we employed ILP with rTNF-alpha and melphalan in 13 patients with unresectable bone sarcoma of the lower extremity, all of whom were candidates for amputation. The aim was to reduce tumour size and allow the performance of a limb-sparing surgery (LSS).
  
  
  RESULTS
  Following ILP, none of the patients had severe local toxicity and only one patient experienced significant systemic side-effects. LSS was subsequently performed in nine of the 13 patients. LSS was feasible in an additional three patients but was not performed because of the emergence of diffused metastatic disease.
  
  
  CONCLUSIONS
  ILP with rTNF-alpha and melphalan can allow limb salvage in patients wih locally advanced bone sarcomas who had failed standard treatment options. Its potential role in the treatment of unresectable bone sarcomas of the extremities merits further evaluation.
authors.affiliation: The National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Bickels
authors.forename: E R
authors.initials: ER
authors.lastname: Manusama
authors.forename: M
authors.initials: M
authors.lastname: Gutman
authors.forename: A M
authors.initials: AM
authors.lastname: Eggermont
authors.forename: Y
authors.initials: Y
authors.lastname: Kollender
authors.forename: S
authors.initials: S
authors.lastname: Abu-Abid
authors.forename: A N
authors.initials: AN
authors.lastname: Van Geel
authors.forename: D
authors.initials: D
authors.lastname: Lev-Shlush
authors.forename: J M
authors.initials: JM
authors.lastname: Klausner
authors.forename: I
authors.initials: I
authors.lastname: Meller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology; D010478:Chemotherapy, Cancer, Regional Perfusion; D005260:Female; D006801:Humans; D007866:Leg; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012509:Sarcoma / Q000188:drug therapy* / Q000556:secondary; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan