Hoven-Gondrie Miriam L, Bastiaannet Esther, van Ginkel Robert J, Pras E Betty, Suurmeijer Albert J H, Hoekstra Harald J
Universitair Medisch Centrum Groningen, Afd. Chirurgische Oncologie, Groningen, the Netherlands.
Ned Tijdschr Geneeskd. 2013;157(30):A6148.
To evaluate the long-term results of 20 years of experience with isolated limb perfusion (ILP) with tumour necrosis factor α (TNF-α) and melphalan, followed by surgical resection and adjuvant radiotherapy, for the treatment of advanced soft tissue sarcomas of the extremities.
Retrospective cohort study.
From 1991 to 2011, 113 patients with primary irresectable soft tissue sarcomas underwent 117 ILPs at the University Medical Centre Groningen. 96 ILPs (82%) were performed in the lower limb, and 21 (18%) in the upper limb. The dosages used were 1-4 mg TNF-α and 10-13 mg/l melphalan.
After a median follow up of 8 (range 2-15) weeks after ILP, 107 tumours were resected: 81 (76%) of the resection margins were tumor-free. After the resection, 69 patients (61%) received adjuvant radiotherapy. In total, 85 ILPs resulted in a tumoural response; 16 patients (14%) developed a local recurrence and after 46 treatments (39%), distant metastases had developed. After a median follow-up of 51 months, the limb had been spared in 88 patients (78%). The 10- year disease-specific survival was 53.8%. There was a median follow-up period of 76 months (range: 7-234); still alive at the end of this period were 56 patients (50%). A total of 83 perfusion- or resection-related complications occurred from 58 ILPs (50%): 55 (66%) early and 28 (34%) late treatment-related complications. None of the patients died as a result of the treatment.
ILP is a safe and effective procedure in the treatment of advanced primary irresectable soft tissue sarcoma that can prevent amputation in many cases. It is however associated with significant morbidity and is burdensome for the patient.
评估采用肿瘤坏死因子α（TNF-α）和美法仑进行肢体隔离灌注（ILP）20年的长期效果，随后进行手术切除及辅助放疗，用于治疗晚期肢体软组织肉瘤。
回顾性队列研究。
1991年至2011年期间，113例原发性不可切除软组织肉瘤患者在格罗宁根大学医学中心接受了117次ILP治疗。96次ILP（82%）在下肢进行，21次（18%）在上肢进行。使用的剂量为1 - 4毫克TNF-α和10 - 13毫克/升美法仑。
ILP后中位随访8周（范围2 - 15周），107例肿瘤被切除：81例（76%）切除边缘无肿瘤。切除后，69例患者（61%）接受辅助放疗。总计85次ILP产生肿瘤反应；16例患者（14%）出现局部复发，46次治疗后（39%）出现远处转移。中位随访51个月后，88例患者（78%）肢体得以保留。10年疾病特异性生存率为53.8%。中位随访期为76个月（范围：7 - 234个月）；在此期间结束时仍存活56例患者（50%）。58次ILP（50%）共发生83例与灌注或切除相关的并发症：55例（66%）为早期，28例（34%）为晚期治疗相关并发症。无患者因治疗死亡。
ILP是治疗晚期原发性不可切除软组织肉瘤的一种安全有效的方法，在许多情况下可避免截肢。然而，它会带来显著的发病率，且对患者来说负担较重。
