Posters— Surgical Treatment of Sarcomas

TREATMENT OF NON-RESECTABLE SOFT TISSUE SARCOMA OF THE LIMBS BY ISOLATED LIMB PERFUSION

Vaglini M, Gronchi A, Pennacchioli E, Deraco M, Baratti D, Bertulli R, Casali PG, Lozza L, Rasponi A, Dileo P, Pilotti S, Azzarelli A (Istituto Nazionale Tumori, Milan, Italy)

Intervention: Isolated limb perfusion (ILP) is a sophisticated technique with theoric advantages. In difficult cases it is one of the most effective neoadjuvant treatments, able to implement conservative surgery and local control. A real impact on survival has yet to be demonstrated.

Patients: From August 1982 to February 2000, we observed 949 pts affected by extremity soft tissue sarcoma (girdles excluded): 68 (36 males and 32 females, mean age 48.3 years) were judged non-resectable and were then treated by ILP. The mean follow-up was 30.5 months (range 0-174). Site, histology and grade were normally represented. The ILP was carried out with Antiblastic drug alone in 45 (64%) patients and Antiblastic + Recombinant Tumor Necrosis Factor a (rTNFa) in 25 (36%) patients. A delayed resection of the residual tumor was done 1 to 2 months after ILP.

Results: There was no treatment related mortality. Regional toxicity, according to the Wieberdink scale, was observed in 25(36%) patients grade II, 7(10%) grade III, 5 (7%) grade IV and 3 (4%) grade V. The later group underwent amputation or disarticulation. Ten (14%) patients presented nerve injury. Systemic toxicity was observed in 5 (7%) cases. Limb salvage was achieved in 61/70 (87%). An overall (complete + partial) immediate response was obtained in 55 (79%) patients. After resection of the residual tumor the pathological response rates was 24 (34%) CR, 31 (44.3%) PR, 6 (9%) NR, 1 (1%) PRO and 8 (11%) data not available. Six (9%) no responder patients underwent amputation or disarticulation. In the TNF group, CR was achieved in 64%, while in the no-TNF group CR was observed in 18% (c²: p<<0.05). In the TNF group the overall response (CR+PR) was achieved in 88% while in the no-TNF group CR+PR was obtained in 73% (c²: p=0.15). Five-year OS in the TNF and no-TNF group were 65% and 46%, respectively (p=0.0047).

Conclusions: ILP is an effective treatment with acceptable morbidity and toxicity. The addition of rTNFa seems to improve the rate of CR and subsequent survival. Nevertheless the high limb salvage rate, observed in our experience, is still the main determinant to define this approach as first choice treatment for non resectable or marginally resectable soft tissue limb sarcomas.