title: Isolated limb perfusion for the management limb threatening soft tissue sarcomas: The role of histological type on clinical outcomes.
abstract: BACKGROUND
  Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes.
  
  
  METHODS
  This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS).
  
  
  RESULTS
  On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7% vs 66/84, 78.6%, P-value: 0.048; mean histological necrosis: 83.6% vs 52.9%, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1% vs 62/84, 73.8%, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009).
  
  
  CONCLUSIONS
  HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process.
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: marco.rastrelli@ioveneto.it.
authors.forename: M
authors.initials: M
authors.lastname: Rastrelli
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: simone.mocellin@ioveneto.it.
authors.forename: S
authors.initials: S
authors.lastname: Mocellin
authors.affiliation: Radiology Unit, University of Padova, Padua, Italy. Electronic address: roberto.stramare@unipd.it.
authors.forename: R
authors.initials: R
authors.lastname: Stramare
authors.affiliation: Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: antonella.brunello@ioveneto.it.
authors.forename: A
authors.initials: A
authors.lastname: Brunello
authors.affiliation: Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: marco.maruzzo@ioveneto.it.
authors.forename: M
authors.initials: M
authors.lastname: Maruzzo
authors.affiliation: Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: umberto.basso@ioveneto.it.
authors.forename: U
authors.initials: U
authors.lastname: Basso
authors.affiliation: Radiotherapy Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: giovanni.scarzello@ioveneto.it.
authors.forename: G
authors.initials: G
authors.lastname: Scarzello
authors.affiliation: Radiotherapy Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: mariasamaritana.buzzaccarini@ioveneto.it.
authors.forename: M S
authors.initials: MS
authors.lastname: Buzzaccarini
authors.affiliation: Surgical Unit, S. Antonio Hospital, Padua, Italy. Electronic address: pl.pilati@unipd.it.
authors.forename: P
authors.initials: P
authors.lastname: Pilati
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: luca.saadeh@gmail.com.
authors.forename: L M
authors.initials: LM
authors.lastname: Saadeh
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: paolo.delfiore@ioveneto.it.
authors.forename: S P
authors.initials: SP
authors.lastname: Del Fiore
authors.affiliation: Pathology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: annalisa.tosi@ioveneto.it.
authors.forename: A
authors.initials: A
authors.lastname: Tosi
authors.affiliation: Pathology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: cristina.montesco@ioveneto.it.
authors.forename: C
authors.initials: C
authors.lastname: Montesco
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: luca.campana@ioveneto.it.
authors.forename: L G
authors.initials: LG
authors.lastname: Campana
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: saveria.tropea@ioveneto.it.
authors.forename: S
authors.initials: S
authors.lastname: Tropea
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padua, Italy. Electronic address: carlor.rossi@unipd.it.
authors.forename: C R
authors.initials: CR
authors.lastname: Rossi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D010478:Chemotherapy, Cancer, Regional Perfusion; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Hyperthermia; Liposarcoma; Melphalan; Perfusion; Tumor necrosis factor