Isolated Limb Perfusion and External Beam Radiotherapy for Soft Tissue Sarcomas of the Extremity: Long-Term Effects on Normal Tissue According to the LENT-SOMA Scoring System

Abstract

Background: With the combined treatment procedure of isolated limb perfusion (ILP), delayed surgical resection and external beam radiotherapy (EBRT) for locally advanced soft tissue sarcomas (STS) of the extremities, limb salvage rates of more than 80% can be achieved. However, long-term damage to the healthy surrounding tissue cannot be prevented. We studied the late effects on the normal tissue using the LENT-SOMA scoring system.Patients and Methods: A total of 32 patients-median age 47 (range 14-71) years-were treated for a locally advanced STS with ILP, surgical resection and often adjuvant 60-70 Gy EBRT. After a median follow-up of 88 (range 17-159) months, the patients were scored, using the LENT-SOMA scales, for the following late tissue damage: muscle/soft tissue, peripheral nerves, skin/subcutaneous tissue and vessels.Results: According to the individual SOM parameters of the LENT-SOMA scales, 20 patients (63%) scored grade-3 toxicity on one or more separate items, reflecting severe symptoms with a negative impact on daily activities. Of these patients, 3 (9%) even scored grade-4 toxicity on some of the parameters, denoting irreversible functional damage necessitating major therapeutic intervention.Conclusions: In evaluating long-term morbidity after a combined treatment procedure for STS of the extremity, using modified LENT-SOMA scores, two-thirds of patients were found to have experienced serious late toxic effects.

Radiotherapy for Soft Tissue Sarcomas after Isolated Limb Perfusion and Surgical Resection: Essential for Local Control in All Patients?

“…Hoven-Gonderie et al28 reported that two-thirds of all patients experienced serious late toxic problems after combined treatment for STS. Major problems with wound healing and continuous wound infections (8–14%) are described in literature 29,30.…”

“…Kalman et al32 described four cases of long-term vascular side-effects in the axillary artery after mastectomy with adjuvant RTx, 10–27 years after treatment. RTx may cause neuropathy, especially when a boost is given 28,33…”

Isolierte Extremitätenperfusion mit TNFα und Zytostatika: eine Revolution in der Behandlung lokal fortgeschrittener Weichgewebssarkome der Extremitäten

“…Therefore, radiation therapy after delayed surgical resection following ILP has been proposed to improved local control, as retrospective studies have demonstrated a significantly lower local recurrence rate for patients receiving adjuvant radiotherapy [148,149]. Although some reports have focused on the morbidity of this combined approach [150][151][152], the only study available comparing a series of 34 consecutive patients who were either additionally treated with radiotherapy after ILP or not found no differences in treatment-related toxicity between the two groups at a median follow-up of 34 months [148].…”

Isolated limb perfusion with biochemotherapy and oncolytic virotherapy combines with radiotherapy and surgery to overcome treatment resistance in an animal model of extremity soft tissue sarcoma

“…The curative treatment protocol developed in our model was intensive, although it was well tolerated with no increase in wound complications or functional morbidity when compared with other cohorts. In clinical practice, the combination of ILP, surgery and postoperative radiotherapy has been shown to be associated with poorer wound healing and long‐term functional morbidity in up to two‐thirds of patients . In the presence of an adequate response to ILP, as determined histologically by the percentage of necrosis of the specimen, adjuvant radiotherapy has not been shown to be of further benefit in securing local disease control .…”