Efficacy of high vs low dose TNF-isolated limb perfusion for locally advanced soft tissue sarcoma

被引:9
|
作者
Nachmany, I. [1 ]
Subhi, A. [1 ]
Meller, I. [2 ]
Gutman, M. [1 ]
Lahat, G. [1 ]
Merimsky, O. [3 ]
Klausner, J. M. [1 ]
机构
[1] Tel Aviv Univ, Sackler Sch Med, Tel Aviv Sourasky Med Ctr, Dept Surg B, IL-69978 Tel Aviv, Israel
[2] Tel Aviv Univ, Sackler Sch Med, Tel Aviv Sourasky Med Ctr, Orthoped Oncol Dept, IL-69978 Tel Aviv, Israel
[3] Tel Aviv Univ, Sackler Sch Med, Tel Aviv Sourasky Med Ctr, Inst Oncol, IL-69978 Tel Aviv, Israel
来源
EJSO | 2009年 / 35卷 / 02期
关键词
Isolated limb perfusion; ILP; TNF-alpha; Limb sarcoma; TUMOR-NECROSIS-FACTOR; FACTOR-ALPHA; MELPHALAN; EXTREMITY; SALVAGE; RATS;
D O I
10.1016/j.ejso.2008.01.007
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Aims: The administration of a high close of rTNF-alpha. (3-4 mg) and Melphalan via isolated limb perfusion (ILP) for patients with locally advanced limb STS was shown to be effective. Reports that a low close of TNF (I mg) is as effective, led to the adoption of the low dose regimen as the treatment of choice. The purpose of this study was to compare two groups of patients with locally advanced limb STS. that was treated with high and low close TNF-ILP, in terms of limb preservation. Methods: Retrospective study of 41 patients who underwent ILP, with "high dose" (HD) and "low dose" (LD) TNF. ILP/TNF was performed on candidates to either amputation or significantly mutilating surgery without this treatment. In both groups, all patients, with the exception of three in each group, underwent resection of the residual tumor or tumor bed or limb 8-12 weeks after the procedure. Results: In the HD group, marked tumor softening occurred within 48 h. and in tumors protruding through the skin, hemorrhagic necrosis was evident within 24 h. The overall response rate was 65.2%. Five patients achieved a CR and 10 had a PR; in five of these patients >90% necrosis of the tumor occurred. In eight patients, only minimal regression was observed (stabilization of disease). The rate of limb sparing was 69.5%. In the LD group, the overall response rate was 30.7%. CR was achieved in one patient. PR was observed in two. Two patients were lost to follow up. Of the remaining 15 patients, limb preservation was achieved in 53.3%. Conclusion: Despite the retrospective comparison and possible selection bias, it is possible to raise the concern that at least some patients may benefit from a higher TNF dose perfusion in ILP for advanced limb STS. Published by Elsevier Ltd.
引用
收藏
页码:209 / 214
页数:6
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