Department of Medical Oncology, Gustave Roussy Cancer Campus, 114, rue Edouard Vaillant, 94805, Villejuif Cedex, France.
Department of Surgical Oncology, Roussy Cancer Campus Gustave, Villejuif, France.
Clin Transl Oncol. 2019 Sep;21(9):1135-1141. doi: 10.1007/s12094-019-02034-w. Epub 2019 Jan 17.
Limb-sparing surgery in locally advanced soft tissue sarcomas (LA STS) is challenging. The aim of this study is to evaluate upfront isolated limb perfusion (ILP) in untreated patients with LA STS.
All consecutive patients with LA STS of the limbs deemed borderline or unresectable and treated with upfront ILP as induction treatment between 2003 and 2016 were included. Demographic, clinical and long-term characteristics were obtained and retrospectively analyzed.
41 patients (pts), with a median age of 51 years [range 21-76], were identified (lower limb 68%, upper limb 32%). Liposarcoma and undifferentiated pleomorphic sarcoma were the most common subtypes (27% and 22%, respectively). Acute toxicities, using Wieberdink classification, were grade II (35 pts, 85%), grade III (2 pts, 5%) and no grade IV-V. Local control rate was 98%. 32 pts had limb-sparing surgery (78%). 1 pt had an early amputation due to progressive disease after ILP. 8 pts were not operated (four had RT alone, one had distant metastases, two had a complete response and one died 3 months after ILP of a pulmonary embolism). 36 pts (84%) received postoperative RT. After a median follow-up of 43 months, 18 pts (47%) relapsed. Median disease-free survival (DFS) was 6.7 years. The median overall survival (OS) was not reached. The 1-year, 5-year and 10-year DFS and OS rates were, respectively, 75%, 50% and 45%, and 90%, 63% and 55%.
Upfront ILP is an efficient and well-tolerated limb-sparing procedure in borderline or unresectable LA STS without hampering OS.
局部晚期软组织肉瘤（LA STS）的保肢手术极具挑战性。本研究旨在评估未经治疗的 LA STS 患者行 upfront 孤立肢体灌注（ILP）的疗效。
纳入 2003 年至 2016 年间，接受 upfront ILP 作为诱导治疗的边界性或不可切除的 LA STS 患者。收集患者的人口统计学、临床和长期特征，并进行回顾性分析。
共纳入 41 例患者（pts），中位年龄为 51 岁[范围 21-76]，其中下肢 68%，上肢 32%。最常见的亚型为脂肪肉瘤和未分化多形性肉瘤（分别为 27%和 22%）。根据 Wieberdink 分级，急性毒性为Ⅱ级（35 例，85%）、Ⅲ级（2 例，5%），无Ⅳ-Ⅴ级。局部控制率为 98%。32 例患者行保肢手术（78%）。1 例患者因 ILP 后疾病进展而行早期截肢。8 例患者未行手术（4 例单纯接受放疗，1 例出现远处转移，2 例获得完全缓解，1 例在 ILP 后 3 个月因肺栓塞死亡）。36 例（84%）患者术后接受放疗。中位随访 43 个月后，18 例（47%）患者复发。中位无疾病生存（DFS）时间为 6.7 年。中位总生存（OS）时间尚未达到。1 年、5 年和 10 年 DFS 率分别为 75%、50%和 45%，OS 率分别为 90%、63%和 55%。
upfront ILP 是一种有效且耐受性良好的保肢手术，适用于边界性或不可切除的 LA STS，不影响 OS。
