title: TNFalpha-based isolated perfusion for limb-threatening soft tissue sarcomas: state of the art and future trends.
abstract: The management of limb-threatening soft tissue sarcomas has not yet been standardized. Although local disease control does not affect overall survival, amputation or highly mutilating surgery may be required, which impairs the patient's quality of life. Various neoadjuvant approaches have been proposed to allow limb-sparing surgery for these locally advanced tumors. With TNFalpha-based hyperthermic isolated limb perfusion, the majority of patients can be spared amputation, with acceptable rates of locoregional and systemic complications. As yet, no other available treatment seems to give comparable results when applied to limb-threatening soft tissue sarcomas. Nevertheless, several issues remain to be addressed, such as the type and dose of drugs, repeatability of the procedure, association with radiotherapy, further indications, and evaluation of response. The authors describe the principles underlying TNFalpha-based hyperthermic isolated limb perfusion, review the worldwide experience so far published, and discuss the above issues. The potential future developments of this locoregional therapeutic approach will also be reported.
authors.affiliation: Department of Oncological and Surgical Sciences, University of Padova, Italy. carlor.rossi2unipd.it
authors.forename: Carlo Riccardo
authors.initials: CR
authors.lastname: Rossi
authors.forename: Simone
authors.initials: S
authors.lastname: Mocellin
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Pilati
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
authors.forename: Mario
authors.initials: M
authors.lastname: Lise
mesh_terms: D010478:Chemotherapy, Cancer, Regional Perfusion; D006801:Humans; D006979:Hyperthermia, Induced; D010477:Perfusion; D011379:Prognosis; D012509:Sarcoma / Q000473:pathology* / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000473:pathology* / Q000628:therapy*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D014409:Tumor Necrosis Factor-alpha