ANGIOGRAPHIC RESPONSE OF LOCALLY ADVANCED SOFT-TISSUE SARCOMA FOLLOWING HYPERTHERMIC ISOLATED LIMB PERFUSION WITH TUMOR-NECROSIS-FACTOR

Background: Hyperthermic isolated limb perfusion (HILP) with tumor nec rosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and melp halan is associated with a dramatic anti-tumor effect in which the neo -vascularization of the tumor is supposed to be the major target, The aim of the present study was to correlate the angiographic findings wi th the pathological response in patients undergoing HILP for locally a dvanced soft-tissue sarcoma, Patients and Methods: Twenty-five patient s, 14 male and 11 female, mean age 47 years (range 18-80) were studied . Angiographies were performed before and a median period of 7 weeks ( range 4-14 weeks) after HILP. Eight weeks after perfusion, the residua l tumor mass was resected and pathologically examined, The changes in tumor vascularization after treatment were scored and compared with th e pathological response, Results: All baseline angiograms showed a hyp ervascular tumor. After HILP, a normal angiography result (NA) was obs erved in 18 patients (72%) and an abnormal angiography result (AA) was observed in seven patients (28%). All patients with an NA showed a pa thologically complete response (pCR) or a pathological partial respons e with >90% necrosis of the tumor, Of seven patients with an AA, patho logical examination showed a PCR in one patient, 10-50% viable tumor v olume in four patients, and no pathological response after perfusion i n two patients. A good correlation was seen between angiographic and p athological classification (p < 0.001), Conclusion: An angiography per formed after hyperthermic isolated limb perfusion with TNF-alpha and m elphalan provides a good indication, regardless of whether a good path ological response is expected.