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Treatment modifications in tumour necrosis factor-α (TNF)-based isolated limb perfusion in patients with advanced extremity soft tissue sarcomas.
- Source :
-
European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2015 Feb; Vol. 51 (3), pp. 367-73. Date of Electronic Publication: 2014 Dec 16. - Publication Year :
- 2015
-
Abstract
- Background: Tumour necrosis factor-α (TNF) and melphalan based isolated limb perfusion (TM-ILP) is an attractive treatment option for advanced extremity soft tissue sarcomas (STS). This study reports on a 20-year single centre experience and discusses the evolution and changes in methodology since the introduction of TNF in ILP.<br />Patients and Methods: We performed 306 TM-ILPs in 275 patients with extremity STS. All patients were candidates for amputation or mutilating surgery in order to achieve local control. Clinical response evaluation consisted of clinical examination and magnetic resonance imaging. To evaluate the importance of TNF-dose, treatment results of two periods (1991-2003 high dose (3-4 mg) TNF; 2003-2012 reduced dose (1-2mg) TNF) were compared.<br />Results: During the study period, more femoral perfusions were done instead of iliac perfusions. Reduction of TNF dose and reduction of total ILP time did not lead to different clinical response rates (70% and 69% for periods 1 and 2 respectively) or different local recurrence rates, but was associated with less local toxicity (23% and 14% for periods 1 and 2 respectively). Hospital stay was significantly reduced during the study period. There was an improved pathological response in the high dose TNF group without consequences for clinical outcome.<br />Conclusion: TM-ILP remains a very effective treatment modality for limb threatening extremity STS. Moreover, reduction of dose and the growing experience in ILP led to less local toxicity and shorter hospital stay.<br /> (Copyright © 2014 Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Aged
Antineoplastic Combined Chemotherapy Protocols adverse effects
Disease Progression
Dose-Response Relationship, Drug
Extremities
Female
Humans
Male
Melphalan adverse effects
Middle Aged
Neoplasm Recurrence, Local drug therapy
Neoplasm Recurrence, Local mortality
Perfusion
Retrospective Studies
Sarcoma mortality
Sarcoma pathology
Soft Tissue Neoplasms mortality
Soft Tissue Neoplasms pathology
Survival Analysis
Treatment Outcome
Tumor Necrosis Factor-alpha adverse effects
Antineoplastic Combined Chemotherapy Protocols administration & dosage
Melphalan administration & dosage
Sarcoma drug therapy
Soft Tissue Neoplasms drug therapy
Tumor Necrosis Factor-alpha administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0852
- Volume :
- 51
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- European journal of cancer (Oxford, England : 1990)
- Publication Type :
- Academic Journal
- Accession number :
- 25529370
- Full Text :
- https://doi.org/10.1016/j.ejca.2014.11.020