Schwarzbach M, Lehnert T, Willeke F, Hinz U, Herfarth C
Chirurgische Klinik und Poliklinik, Universität Heidelberg.
Chirurg. 1996 Dec;67(12):1237-43. doi: 10.1007/s001040050132.
Soft-tissue sarcomas (STS) of the extremities are characterized by a high rate of local recurrences. Limb salvage approaches using multimodality therapy protocols have replaced amputation. In order to evaluate isolated hyperthermic limb perfusion (ILP) in a multimodality therapy concept, we reviewed our patients treated using this method. Between January 1982 and December 1995, 25 ILPs, using cisplatin, melphalan and adriamycin, were performed in 22 patients with STS. Forty percent were treated for local recurrences; histology was dominated by malignant fibrous histiocytoma (MFH) and synovial sarcoma. In all, 68% of the STS were classified as UICC stage IIb or IIIa/b. Most of the cases (14) underwent wide or radical resection, 4 patients received intraoperative radiotherapy, and 5 were treated with external beam radiation. Complications were recorded in 32% of the cases. With a median follow-up of 45 months (range 1-143), the 5-year overall survival rate was 81%. The median recurrence-free time was 19 months and the 5-year disease-free survival rate 34%. There were 13 local failures, and distant metastases developed in 36% of the patients. Concerning high-grade sarcomas (UICC stage IIb, IIIa/b), we found local recurrences in 75% of all cases. Five of 11 patients with local failures underwent perfusion after they refused amputation, and 7 incompletely resected STS received ILP without reoperation. All of these demonstrated local recurrence. This rate of local recurrence proved to be different from patients with tumor-free resection margins (p = 0.0001, log-rank test). The amputation rate after isolated limb perfusion was 27% (mean 11 months after treatment). Long-term results of ILP showed a considerable local recurrence rate and a low disease-free survival. Perfusion in patients without tumor-free resection margins does not prevent local recurrence. We conclude that ILP with cisplatin, melphalan and adriamycin should be considered carefully and is not an additional treatment strategy of fist choice.
肢体软组织肉瘤（STS）的特点是局部复发率高。采用多模式治疗方案的保肢方法已取代截肢术。为了在多模式治疗概念中评估孤立性热灌注肢体疗法（ILP），我们回顾了采用该方法治疗的患者。1982年1月至1995年12月期间，对22例STS患者进行了25次使用顺铂、美法仑和阿霉素的ILP治疗。40%的患者因局部复发接受治疗；组织学上以恶性纤维组织细胞瘤（MFH）和滑膜肉瘤为主。总体而言，68%的STS被归类为国际抗癌联盟（UICC）IIb期或IIIa/b期。大多数病例（14例）接受了广泛或根治性切除，4例患者接受了术中放疗，5例接受了外照射放疗。32%的病例记录有并发症。中位随访时间为45个月（范围1 - 143个月），5年总生存率为81%。中位无复发生存时间为19个月，5年无病生存率为34%。有13例局部复发，36%的患者发生远处转移。对于高级别肉瘤（UICC IIb期、IIIa/b期），我们发现所有病例中有75%发生局部复发。11例局部复发患者中有5例在拒绝截肢后接受了灌注治疗，7例不完全切除的STS未再次手术直接接受了ILP治疗。所有这些病例均出现局部复发。这种局部复发率被证明与切缘无肿瘤的患者不同（p = 0.0001，对数秩检验）。孤立性肢体灌注后的截肢率为27%（平均治疗后11个月）。ILP的长期结果显示局部复发率相当高，无病生存率低。切缘无肿瘤的患者进行灌注并不能预防局部复发。我们得出结论，顺铂、美法仑和阿霉素的ILP应谨慎考虑，并非首选的额外治疗策略。
