EFFICACY OF TUMOR-NECROSIS-FACTOR-ALPHA ( RTNF-ALPHA) ASSOCIATED TO INTERFERON-GAMMA (IFN-GAMMA) AND TO CHEMOTHERAPY IN ISOLATED LIMB PERFUSION FOR INOPERABLE MALIGNANT-MELANOMA, SOFT-TISSUE SARCOMA AND EPIDERMOID CARCINOMA - A 4-YEAR EXPERIENCE

The authors review their experience of 4 years with isolated limb perf usion for the application of high dose TNF-alpha associated to IFN-gam ma melphalan for the treatment of regionally advanced tumours such as malignant melanoma, soft tissue sarcoma and epidermoid carcinoma. In m alignant melanoma, the complete remission rate reaches 91%. In irresec table soft tissue sarcoma, this treatment when used as a neoadjuvant t reatment saves the limb from amputation in 87.5% of the cases. Similar results are obtained for epidermoid carcinoma. With the regional appl ication of high doses of TNF-alpha associated to chemotherapy and IFN- gamma it has been possible to validate the concept of a strategy based on a dual targeting, that is the selective impact of the intratumoral vessels by TNF-alpha and of the tumour cells by chemotherapy. This ap proach appears to be the treatment of choice for locally advanced tumo urs of the limbs. However, as a single therapy, this procedure should be considered in melanoma as an induction therapy, and in sarcoma, as a preoperative treatment.