PHASE-II STUDY ON NEOADJUVANT HYPERTHERMIC-ANTIBLASTIC PERFUSION WITHDOXORUBICIN IN PATIENTS WITH INTERMEDIATE OR HIGH-GRADE LIMB SARCOMAS

Background. Locoregional control of soft tissue sarcomas of the limbs is achieved generally using a multidisciplinary approach consisting of conservative surgery combined with radiation therapy, intraarterial c hemotherapy, or hyperthermic antiblastic perfusion (HAP). Before surge ry, HAP seems to be the more suitable tool in decreasing tumor mass an d allowing limb-sparing surgery. The authors' aim was to ascertain the activity of HAP with doxorubicin against intermediate or high grade l imb tumors. Methods. In 23 patients with limb sarcomas (2 patients Int ernational Union Against Cancer Stage IIA, 4 stage IIB, 1 stage IIIA, 11 stage IIIB, and 5 stage IVB) doxorubicin was administered via HAP 4 -6 weeks before surgery. The drug (bolus, 0.7-1.4 mg/kg) was perfused for 60 minutes with a tumor temperature of at least 40.5 degrees C (ra nge, 40.5-42.6 degrees]. Tumor necrosis was then assessed radiological ly and pathologically. Results. Systemic toxicity was hematologic grad e (G) 2 in 2 patients, gastrointestinal (hepatic) in 6, G1 in 2, G2 in 3, and G3 in 1; 2 patients had alopecia; locoregional toxicity (grade d according to Wieberdink) was G1 or G2 in 18, G3 in 4, and G4 in 1. T umor necrosis was more than 50% in 17 patients (74%). Limb-sparing sur gery was feasible in 20 patients (91%). At present, 14 patients are al ive. Six had local recurrences, and eight had distant metastases. Conc lusions. Our findings show that HAP with doxorubicin is an active and well-tolerated procedure within a multidisciplinary approach to treatm ent of limb sarcomas.