肢体威胁性肉瘤的孤立肢体灌注治疗。
Isolated Limb Infusion for Limb-Threatening Sarcomas.
机构信息
University of South Florida Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Cutaneous Oncology Department, Moffitt Cancer Center, Tampa, FL, USA.
出版信息
Ann Surg Oncol. 2024 Dec;31(13):9272-9280. doi: 10.1245/s10434-024-16159-y. Epub 2024 Sep 10.
BACKGROUND
Isolated limb infusion (ILI) treats unresectable extremity malignancies with high-dose regional chemotherapy limited to the limb. This study assessed long-term outcomes after ILI for limb-threatening sarcomas.
METHODS
A retrospective review analyzed patients with an extremity sarcoma who underwent ILI with melphalan and dactinomycin from 2008 to 2023 at a single institution.
RESULTS
The study identified 61 patients (52.5% female; median age, 73 years; range, 20-94 years). Of these patients, 68.9% had lower-extremity disease. The median follow-up period was 6.9 years. The overall response rate was 48.3% (complete response [CR], 21.7%; partial response [PR], 26.7%), and the disease control rate (DCR: CR + PR + stable disease [SD]) was 65%. The median progression-free survival (PFS) for the patients with CR/PR/SD/progressive disease (PD) was respectively 16.8/9.6/4.8/2.4 months (P < 0.0001). The responders (CR + PR) had significantly longer PFS than the non-responders (SD + PD) (hazard ratio [HR], 6.3; 95% confidence interval [CI], 3.1-12.9; P < 0.001). The median in-field PFS times for CR/PR/SD/PD were respectively 16.8/12/4.8/2.4 months (P < 0.001). The responders had a significantly longer risk of in-field PFS than the non-responders (HR, 5.9; 95% CI 2.9-12.0; P < 0.001). The median distant relapse PFS for CR/PR/SD/PD was not reached (NR)/NR/44.4/40.8 months (P = 0.02). The responders had a significantly longer distant relapse PFS than the non-responders (HR, 2.7; range, 1.1-6.8; P = 0.04). The median overall survival (OS) was 8.6 years for the responders and 4.1 years for the non-responders (P = 0.02). The disease-specific survival (DSS) rates were 87% at 1 year, 71% at 3 years, and 64% at 5 years. The median DSS was not reached for the responders and was 4.1 years for the non-responders (P = 0.003). The limb salvage rates at 6 months were 85% at 1 year, 80% at 3 years, and 70% at 5 years. The patients with PD had a higher risk of requiring amputation than the patients with CR + PR + SD (HR, 3.0; 95% CI 1.0-8.7; P = 0.04).
CONCLUSIONS
The 5-year limb salvage rates after ILI are notably high, reaching 70%. After ILI, the responders had significantly better in-field and distant relapse PFS, OS, and DSS.
背景
孤立肢体灌注（ILI）采用大剂量区域化疗治疗无法切除的肢体恶性肿瘤，化疗药物仅作用于肢体。本研究评估了 ILI 治疗肢体威胁性肉瘤的长期疗效。
方法
回顾性分析了 2008 年至 2023 年在一家单中心接受美法仑和放线菌素 D 治疗的肢端肉瘤患者。
结果
共纳入 61 例患者（52.5%为女性；中位年龄为 73 岁；年龄范围为 20-94 岁）。其中 68.9%的患者患有下肢疾病。中位随访时间为 6.9 年。总体缓解率为 48.3%（完全缓解 [CR] 21.7%，部分缓解 [PR] 26.7%），疾病控制率（DCR：CR+PR+稳定疾病 [SD]）为 65%。CR/PR/SD/进展性疾病（PD）患者的中位无进展生存期（PFS）分别为 16.8/9.6/4.8/2.4 个月（P<0.0001）。CR/PR 患者的 PFS 明显长于 SD/PD 患者（HR，6.3；95%CI，3.1-12.9；P<0.001）。CR/PR/SD/PD 患者的中位场内 PFS 时间分别为 16.8/12/4.8/2.4 个月（P<0.001）。CR 患者的场内 PFS 风险明显长于非 CR 患者（HR，5.9；95%CI，2.9-12.0；P<0.001）。CR/PR/SD/PD 患者的远处无复发生存期（DFS）分别未达到（NR）/NR/44.4/40.8 个月（P=0.02）。CR 患者的远处无复发生存期明显长于非 CR 患者（HR，2.7；范围，1.1-6.8；P=0.04）。CR 患者的中位总生存期（OS）为 8.6 年，非 CR 患者为 4.1 年（P=0.02）。CR 患者的疾病特异性生存率（DSS）为 1 年时为 87%，3 年时为 71%，5 年时为 64%。非 CR 患者的中位 DSS 为 4.1 年（P=0.003）。CR 患者的保肢率在 6 个月时为 85%，1 年时为 80%，3 年时为 70%，5 年时为 60%。PD 患者需要截肢的风险明显高于 CR+PR+SD 患者（HR，3.0；95%CI，1.0-8.7；P=0.04）。
结论
ILI 后 5 年的保肢率显著升高，达到 70%。ILI 后，CR 患者的场内和远处无复发生存期、OS 和 DSS 明显更好。
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