title: Isolated limb perfusions with tumor necrosis factor and melphalan for locally recurrent soft tissue sarcoma in previously irradiated limbs.
abstract: BACKGROUND
  Recurrent extremity soft tissue sarcoma (STS) in a previously operated and irradiated area can usually be managed only by amputation. Tumor necrosis factor (TNF)-alpha-based isolated limb perfusion (ILP) is an established alternative to achieve limb salvage but is assumed to require sufficient vasculature. Because radiotherapy is known to destroy vasculature, we wanted to evaluate retrospectively whether the outcome of ILP in patients with radiotherapy for their primary tumor nonetheless showed a benefit from TNF treatment.
  
  
  METHODS
  We consulted a prospective database of TNF-based ILPs at the Erasmus MC-Daniel den Hoed Cancer Center in Rotterdam. Out of 342 TNF-based ILPs between 1991 and 2003, 30 ILPs were performed in 26 patients with recurrent STS in the irradiated field after prior surgery and radiotherapy. Eleven patients (42%) had multiple tumors (n = 2-20). All patients were candidates for amputation.
  
  
  RESULTS
  We observed 6 complete responses (20%), 15 partial responses (50%), no change in 8 patients (27%), and progressive disease in 1 patient (3%). The median duration of response was 16 months (range, 3-56 months) at a median follow-up of 22 months (range, 3-67 months). The local recurrence rate was 45% in patients with multiple tumors and 27% in patients with single tumors. Ten patients (35%) died of systemic metastases. Limb salvage was achieved in 17 patients (65%). Regional toxicity was limited and systemic toxicity minimal.
  
  
  CONCLUSIONS
  TNF-based ILP can avoid amputations in most patients with recurrent extremity STS in a prior operated and irradiated field.
authors.affiliation: Department of Surgical Oncology, Erasmus MC-Daniel den Hoed Cancer Center, PO Box 5201, 3008 AE Rotterdam, The Netherlands.
authors.forename: T E
authors.initials: TE
authors.lastname: Lans
authors.forename: D J
authors.initials: DJ
authors.lastname: Grünhagen
authors.forename: J H W
authors.initials: JH
authors.lastname: de Wilt
authors.forename: A N
authors.initials: AN
authors.lastname: van Geel
authors.forename: A M M
authors.initials: AM
authors.lastname: Eggermont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D001132:Arm; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007866:Leg; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage*
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan