Isolated limb perfusion with tumour necrosis factor-alpha and melphalan for unresectable bone sarcomas of the lower extremity

Aims: Isolated limb perfusion (ILP) with recombinant tumour necrosis factor -alpha (rTNF-alpha) and melphalan has recently been reported to induce majo r tumour responses and permit limb salvage in over 80% of patients with unr esectable soft-tissue sarcomas of the extremities. We investigated whether TNF-based ILP could allow limb-sparing surgery in patients with primary, re current or metastatic bone sarcoma to the lower extremity who met the crite ria for an amputation and had failed or refused chemotherapy. Methods: From August 1992 to December 1997, we employed ILP with rTNF-alpha and melphalan in 13 patients with unresectable bone sarcoma of the lower e xtremity, all of whom were candidates for amputation. The aim was to reduce tumour size and allow the performance of a limb-sparing surgery (LSS). Results: Following ILP, none of the patients had severe local toxicity and only one patient experienced significant systemic side-effects. LSS was sub sequently performed in nine of the 13 patients. LSS was feasible in an addi tional three patients but was not performed because of the emergence of dif fused metastatic disease. Conclusions: ILP with rTNF-alpha and melphalan can allow limb salvage in pa tients with locally advanced bone sarcomas who had failed standard treatmen t options. Its potential role in the treatment of unresectable bone sarcoma s of the extremities merits further evaluation.