THE RESULTS OF ISOLATED HYPERTHERMIC LIMB PERFUSION IN A MULTIMODALITY THERAPY CONCEPT FOR SOFT-TISSUE SARCOMA

Soft-tissue sarcomas (STS) of the extremities are characterized by a h igh rate of local recurrences. Limb salvage approaches using multimoda lity therapy protocols have replaced amputation. In order to evaluate isolated hyperthermic limb perfusion (ILP) in a multimodality therapy concept, we reviewed our patients treated using this method. Between J anuary 1982 and December 1995, 25 ILPs, using cisplatin, melphalan and adriamycin, were performed in 22 patients with STS. Forty percent wer e treated for local recurrences; histology was dominated by malignant fibrous histiocytoma (MFH) and synovial sarcoma. In all, 68 % of the S TS were classified as UICC stage IIb or IIIa/b. Most of the cases (14) underwent wide or radical resection, 4 patients received intraoperati ve radiotherapy, and 5 were treated with external beam radiation. Comp lications were recorded in 32 % of the cases. With a median follow-up of 45 months (range 1-143), the 5-year overall survival rate was 81 %. The median recurrence-free time was 19 months and the 5-year disease- free survival rate 34 %. There were 13 local failures, and distant met astases developed in 36 % of the patients. Concerning high-grade sarco mas (UICC stage IIb, IIIa/b), we found local recurrences in 75 % of al l cases. Five of 11 patients with local failures underwent perfusion a fter they refused amputation, and 7 incompletely resected STS received ILP without reoperation. All of these demonstrated local recurrence. This rate of local recurrence proved to be different from patients wit h tumor-free resection margins (p = 0.0001, log-rank test). The amputa tion rate after isolated limb perfusion was 27 % (mean 11 months after treatment). Long-term results of ILP showed a considerable local recu rrence rate and a low disease-free survival. Perfusion in patients wit hout tumor-free resection margins does not prevent local recurrence. W e conclude that ILP with cisplatin, melphalan and adriamycin should be considered carefully and is not an additional treatment strategy of f irst choice.