title: Oncological outcome of primary non-metastatic soft tissue sarcoma treated by neoadjuvant isolated limb perfusion and tumor resection.
abstract: BACKGROUND
  Isolated limb perfusion (ILP) is an effective limb salvage strategy in patients with advanced soft tissue sarcoma (STS) where surgery alone would result in significant functional morbidity or mandate an amputation. Most previous reports of patients undergoing ILP focus on limb salvage rates rather than local and distant relapse rates. Here, we report the oncological outcome of sarcoma patients treated by ILP and surgery.
  
  
  METHODS
  Data were retrieved from prospective ILP databases from two ILP centers following similar ILP techniques and surgical approaches. Only patients with primary, intermediate, or high grade non-metastatic STS were included.
  
  
  RESULTS
  The cohort comprised 90 patients. Median follow-up was 39 months (range 3-165 months). Median tumor size was 11 cm (range 5-34). Twenty of 90 (22%) patients underwent prior debulking surgery outside the centers. Twenty-nine of 90 (32%) had postoperative irradiation. Four of 90 underwent amputation either related to local recurrence or irresectability, 4 of 90 underwent amputation for treatment-related complications. Fifteen of 83 (18%) patients had local recurrences after ILP and limb sparing surgery, 39 of 90 (43%) developed metastatic disease. Twenty-two of 90 (24%) died of disease.
  
  
  CONCLUSIONS
  Preoperative ILP and tumor resection resulted in good local control in a cohort of high-risk STS patients.
authors.affiliation: Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Jakob
authors.forename: Per-Ulf
authors.initials: PU
authors.lastname: Tunn
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hayes
authors.forename: Lothar R
authors.initials: LR
authors.lastname: Pilz
authors.forename: Kai
authors.initials: K
authors.lastname: Nowak
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008558:Melphalan / Q000627:therapeutic use*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan
keywords: ILP; TNF; local recurrence; neoadjuvant; preoperative; soft tissue sarcoma