Multifocal soft tissue sarcoma: Limb salvage following hyperthermic isolated limb perfusion with high-dose tumor necrosis factor and melphalan

Background and Objectives: The prognosis for recurrent multifocal limb soft tissue sarcoma (STS) is dismal due to systemic spread. However, many of th ese patients undergo amputation due to ineffective local control. The purpo se of the present study was to determine whether isolated limb perfusion (I LP) with tumor necrosis factor (TNF) and melphalan permits limb salvage and palliation for such patients. Methods: Of 53 STS patients treated with hyperthermic ILP with TNF (3-4 mg) and melphalan (1-1.5 mg/kg), 13 (25%) had multifocal STS and were candidat es for amputation. Results: The overall response rate was 92% (12/13) with 38% complete respon se and 54% partial response. Two patients died during the early postoperati ve period. Limb salvage was achieved in 85% of patients. One patient (8%) h ad only stable disease and underwent amputation. Local recurrence occurred in 38% but did not result in amputation. Conclusions: Although the number of patients in this study is too small to allow definitive conclusions, it seems that ILP/TNF offer limb salvage and palliation for recurrent multifocal STS patients. J. Surg. Oncol. 1999;70:1 85-189, (C) 1999 Wiley-Liss, Inc.