TNF Dose Reduction and Shortening of Duration of Isolated Limb Perfusion for Locally Advanced Soft Tissue Sarcoma of the Extremities Is Safe and Effective in Terms of Long-Term Patient Outcome

Background and Objectives: Dose reduction and shortening of duration of perfusion in isolated limb perfusion with TNF-alpha and Melphalan (TMILP) are associated with less systemic toxicity and seem to be safe and effective on short-term. However, data on long-term patient outcome are scarce.Methods: From 1991 to 2008, 102 TM-ILPs were performed in 98 patients for a locally advanced soft tissue sarcoma of the extremity. Perfusions were categorized in three groups: (A) high dose and long duration (n = 59), (B) high dose and short duration (n 16), and (C) low dose and short duration (n = 27). Long-term local control rates and (limb)-survival were evaluated.Results: Limb salvage rates were in group A 76.3%, B 62.5%, and C 85.2% (P = 0.2). With a median follow up of 76 (range 4-203) months, 50 patients were still alive (51%). Disease-specific 5-year survival was not different between the three groups: A 55.4%, B 52.5%, and C 57.3% (P = 0.9). There was no difference in local recurrence-free 5-year survival (adjusted P = 0.1) and distant metastases-free survival (P = 0.9).Conclusions: Dose reduction and shorter duration of TM-ILP seem to be safe and effective regarding long-term patient outcome, as 5-year local control rates and (limb)-survival are not compromised. J. Surg. Oncol. 2011;103:648-655. (C) 2011 Wiley-Liss, Inc.