Hyperthermic isolated limb perfusion: evolving concepts in the treatment of extremity soft tissue sarcomas

Abstract

Purpose of reviewHyperthermic isolated limb perfusion is an established limb salvage therapy used in the treatment of extremity soft tissue sarcomas. The article reviews recent literature regarding this treatment modality. Recent findingsHyperthermic isolated limb perfusion continues to evolve. Over the last year one large trial has been published evaluating overall outcomes. Recent literature has focused on the efficacy of decreasing tumor necrosis factor-a dosage. Studies have demonstrated similar efficacy between lower doses of tumor necrosis factor-a with decreased side-effects. The role of external beam radiation and hyperthermic isolated limb perfusion is still being established. A new study demonstrated decreased local recurrence rates for patients when surgery and external beam radiation follow hyperthermic isolated limb perfusion. Much is known about short-term complications and morbidity associated with this treatment; however, new documentation is available on long-term quality of life issues as well as post-traumatic responses in these patients. Recent studies also evaluated the palliative value of hyperthermic isolated limb perfusion in stage IV soft tissue sarcomas with locally advanced disease. Summary Hyperthermic isolated limb perfusion continues to garner increased awareness. There are disparities between European and American results, due to differences between treatment regimens. Hyperthermic isolated limb perfusion for patients with extremity sarcomas who would otherwise require amputation is a viable option. To date the best results are from institutions who treat a large number of patients using tumor necrosis factor-a and melphelan.

Apoptotic and necrotic effects of tumour necrosis factor-alpha potentiated with hyperthermia on L929 and tumour necrosis factor-alpha-resistant L929

“…When TNF-is used in ILP, both regional and systemic toxicity in the patients have been reported [42][43][44]. A grading system described by Wieberdink is commonly used to classify the symptoms related to regional toxicity (Table I).…”