Grünhagen Dirk J G, de Wilt Johannes H W, van Geel Albertus N, Verhoef Cornelis, Eggermont Alexander M M
Department of Surgical Oncology, Erasmus MC, Daniel den Hoed Cancer Center, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.
Recent Results Cancer Res. 2009;179:257-70. doi: 10.1007/978-3-540-77960-5_16.
Limb-sparing surgery has become all the more important in soft tissue sarcoma (STS) of the extremities since we learned that amputation does not improve survival of these patients. In bulky tumours, however, preoperative strategies to reduce tumour size are then required. Isolated limb perfusion (ILP) with tumour necrosis factor (TNF) has been developed as a biochemotherapeutic therapy to act both on the tumour-associated vasculature and on the tumour itself. It has shown to be a very potent treatment modality, as in early reports response rates were around 80%. Limb salvage could then be achieved in a quite similar percentage. Many confirmatory studies have been performed since, with consistent results even in patients with multiple tumours, after extensive radiotherapy or with metastatic disease, all at the cost of very limited toxicity. This chapter gives an overview of the ILP studies performed in patients with soft tissue limb sarcoma, discusses the mechanism of TNF-mediated vasculotoxic effects on tumour vasculature, and places TNF-based ILP in the multimodality treatment of these patients with extensive STS of the extremities.
自从我们了解到截肢并不能提高肢体软组织肉瘤（STS）患者的生存率以来，保肢手术在这类疾病中变得愈发重要。然而，对于体积较大的肿瘤，术前需要采取缩小肿瘤大小的策略。肿瘤坏死因子（TNF）隔离肢体灌注（ILP）已发展成为一种生物化疗方法，可作用于肿瘤相关血管和肿瘤本身。它已被证明是一种非常有效的治疗方式，早期报告显示缓解率约为80%。保肢成功率也与此相近。自那时起，许多验证性研究相继开展，即便在患有多发肿瘤、接受过广泛放疗或患有转移性疾病的患者中，也都取得了一致的结果，而且所有这些研究的毒性都非常有限。本章概述了在肢体软组织肉瘤患者中进行的ILP研究，讨论了TNF介导的对肿瘤血管的血管毒性作用机制，并将基于TNF的ILP置于这些患有广泛肢体STS患者的多模式治疗中。
