Division of Surgical Oncology, Daniel den Hoed - Erasmus MC, Rotterdam, The Netherlands.
J Surg Oncol. 2012 May;105(6):563-9. doi: 10.1002/jso.22121. Epub 2011 Oct 21.
Approximately 10% of soft tissue sarcomas (STS) occur in the most distal parts of the extremities. The standard therapy is local excision with adjuvant radiotherapy, but achieving wide resection margins might be difficult in the distal parts of the limb. Tumor necrosis factor-alpha (TNF) and melphalan-based isolated limb perfusion (TM-ILP) is effective in locally advanced STS of the extremities. We report the results of TM-ILP for STS in the most distal parts of the limb.
Between 1991 and 2009, 34 ILPs were performed in patients with irresectable STS of the wrist, hand, ankle, or foot. Disease was unifocal in 21 (62%) patients.
Overall response rate was 71% (n = 24). After a median follow-up of 34 (range 1-143) months the local recurrence rate was 32%. Amputation was unavoidable in four patients (13%), four other patients (13%) underwent a partial amputation of the hand or foot.
With a limb salvage rate of 87%, TM-ILP is an effective treatment modality in patients with distal STS. In all patients with an indication for amputation surgery due to an STS in the distal part of the limb, TM-ILP should be considered.
大约 10%的软组织肉瘤（STS）发生在四肢的最远端。标准疗法是局部切除加辅助放疗，但在肢体的远端实现广泛的切除边缘可能很困难。肿瘤坏死因子-α（TNF）和马法兰为基础的隔离肢体灌注（TM-ILP）在四肢局部晚期 STS 中是有效的。我们报告了 TM-ILP 治疗肢体最远端 STS 的结果。
在 1991 年至 2009 年期间，对 34 例无法切除的腕、手、踝或足部 STS 患者进行了 ILP。21 例（62%）患者为单一病灶。
总缓解率为 71%（n=24）。中位随访 34 个月（范围 1-143）后，局部复发率为 32%。4 例患者（13%）不可避免地进行了截肢，另外 4 例患者（13%）对手或脚进行了部分截肢。
TM-ILP 在治疗远端 STS 患者时具有 87%的保肢率，是一种有效的治疗方法。对于所有因肢体远端 STS 而需要截肢手术的患者，都应考虑 TM-ILP。
