title: [Isolated limb perfusion for liposarcoma : Histopathological response and subgroup analysis after TNF melphalan-based ILP].
abstract: BACKGROUND
  Tumor necrosis factor alpha (TNF) and melphalan-based isolated limb perfusion (TM-ILP) is one of the most effective treatment modalities for unresectable soft tissue sarcoma (STS) of the extremities. Liposarcomas (LS) are a large and heterogeneous subgroup of STS with different biological behavior and prognoses. The aim of this study was to evaluate LS and the different subentities with respect to their responsiveness towards TM-ILP.
  
  
  METHODS
  We matched our ILP database with our pathology database to identify patients who received TM-ILP due to STS followed by resection of the residual tumor. We identified 126 patients who matched these inclusion criteria. In this patient group we identified 24 patients with a LS. Histopathological regression was assessed from all resection specimens and was compared between groups: LS vs. non-LS and for myxoid and non-myxoid LS subgroups.
  
  
  RESULTS
  There were no significant differences in the overall tumor regression comparing non-LS (median 95%, mean 77%) and LS (median 90%, mean 74%). For the subgroup analysis, a higher grade of regression after TM-ILP was found in myxoid-LS (median 95%, mean 79% ± 31.5) compared to the non-myxoid LS (median 75%, mean 72% ± 24.6). Atypical lipomatous tumors (ALT) were less responsive to TM-ILP treatment (median 40%, mean 40%).
  
  
  CONCLUSIONS
  The histopathological response of LS toward TM-ILP is equally good compared to non-lipomatous STS. Myxoid LS seem to have a tendency towards a better response to TM-ILP compared to non-myxoid LS and ALT showed the lowest response rate in the liposarcoma subgroup. Furthermore, we found that TM-ILP seems to facilitate successful R0 resection. Due to the low number of cases in the subgroups we advocate further research on this topic.
authors.affiliation: Sektion Sarkomchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland. lars.podleska@uk-essen.de.
authors.forename: L E
authors.initials: LE
authors.lastname: Podleska
authors.affiliation: Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Schwindenhammer
authors.affiliation: Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Grabellus
authors.affiliation: Innere Klinik/Tumorforschung, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Sektion Sarkomchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland.
authors.forename: H-U
authors.initials: HU
authors.lastname: Steinau
authors.affiliation: Sektion Sarkomchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Westdeutsches Tumorzentrum (WTZ), Hufelandstr. 55, 45147, Essen, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Taeger
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D005121:Extremities; D005260:Female; D006801:Humans; D008080:Liposarcoma / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D008558:Melphalan
keywords: Isolated limb perfusion; Liposarcoma; Melphalan; Sarcoma; TM-ILP; TNF-α