HYPERTHERMIC ISOLATED LIMB PERFUSION WITH TUMOR-NECROSIS-FACTOR AND MELPHALAN AS TREATMENT OF LOCALLY ADVANCED OR RECURRENT SOFT-TISSUE SARCOMAS OF THE EXTREMITIES

Hyperthermic isolated limb perfusion (HILP) with various chemotherapeu tic agents has been used for the local treatment of high-grade soft ti ssue sarcomas (STS) of the extremities, but in most cases with a disap pointing result. Most regimens should certainly not be considered supe rior to surgery plus radiotherapy. Although the majority of extremity STS can be resected locally, some have a very large size and are in cl ose proximity to bones, nerves or blood vessels. In these cases, amput ation is the only means of resecting the tumour. A new combination of drugs used in the set-up of HILP with tumour necrosis factor-alpha and melphalan has emerged as a very promising option for the limb-saving management of locally advanced STS. In recent studies, complete respon se rates of approximately 30% and partial remission rates of 50% have been achieved, while the overall limb-salvage rate is more than 80%. ( C) 1998 Elsevier Science Ireland Ltd. All rights reserved.