Isolated Limb Perfusion and Infusion for Extremity Soft Tissue Sarcoma: A Contemporary Systematic Review and Meta-Analysis

Neuwirth, Madalyn G.; Song, Yun Seon; Sinnamon, Andrew J.; Fraker, Douglas L.; Zager, Jonathan S.; Karakousis, Giorgos C.

doi:10.1245/s10434-017-6109-7

Cited by 51 publications

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“…Comparing ILP/ILI patients diagnosed with melanoma to those with STS, the melanoma patients were slightly older (mean 64 years for melanoma and 59 years for STS), consistent with previous reports of age at the time of procedure for each disease . The mean LOS (4.8 days) following ILP/ILI for melanoma in the current study was most consistent with what is reported in the literature for ILI .…”

Section: Discussionsupporting

confidence: 89%

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Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

Song

Bruce

Fraker

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Isolated limb perfusion (ILP) and infusion (ILI) are treatment modalities for unresectable melanoma in‐transit metastases and extremity soft tissue sarcomas (STS). We sought to characterize the national trend in their utilization in the context of novel melanoma therapies introduced in 2011. Methods Using the National Inpatient Sample (2005‐2014), patients with a primary diagnosis of limb melanoma or STS who underwent ILP/ILI were identified by diagnosis and procedure codes. Annual percent change (APC) in ILP/ILI procedures was determined. Results From 2005 through 2014, 670 and 130 ILP/ILI procedures were performed for melanoma and STS, respectively. Mean age was 64 (SD 15) years for melanoma and 59 (SD 18) years for STS. Over time, procedures for melanoma decreased with an APC of ‐17 (P = .019). Comparing 2005‐2010 and 2011‐2014, the mean number of procedures for melanoma decreased from 91 to 32 per year (P = .007). In contrast, there was no change for STS (APC 6.5, P = .39; mean 11 and 16 per year in 2005‐2010 and 2011‐2014, respectively, P = .46). Conclusions ILI/ILP utilization has decreased for melanoma, but not for STS. Whether trends for ILP and ILI differed could not be determined. ILP/ILI remains an important option to consider for regional disease control.

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Section: Discussionsupporting

confidence: 89%

“…The overall response (OR) rates achieved with ILP are as high as 70%‐90% and complete response (CR) rates up to 60%‐70% . Both methods of regional therapy were subsequently used for patients with locally advanced STS with similar OR rates, but typically lower CR rates ranging from 18%‐30% …”

Section: Introductionmentioning

confidence: 99%

Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

Song

Bruce

Fraker

et al. 2019

Journal of Surgical Oncology

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“… When possible, ILP can be used in a neoadjuvant manner (preoperative) to reduce the dimensions of the primary tumor or improve local conditions, increasing the probability of limb preservation surgery 61 . However, alpha and melphalan NTT are unavailable in most centers in Brazil; thus, we do not recommend this type of treatment outside of institutional protocols with experienced surgeons (IIC) 62 …”

Section: Management Of Local/localized Disease (See Figure 1)mentioning

confidence: 99%

“…61 However, alpha and melphalan NTT are unavailable in most centers in Brazil; thus, we do not recommend this type of treatment outside of institutional protocols with experienced surgeons (IIC). 62…”

Section: Recommendationmentioning

confidence: 99%

Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

Spencer¹,

Camargo²,

Silva³

et al. 2020

Journal of Surgical Oncology

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Introduction Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. Methods This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. Results Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. Conclusion Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.

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“…Interestingly, although the Peritoneal Cancer Index (PCI) score was predictive of ability to cytoreduce, it did not predict survival for patients with high-grade appendiceal or endometrial carcinoma. Wright et al 16 18 In addition, a meta-analysis on the role of isolated limb infusion (ILI) for sarcomas presented by Neuwirth et al 19 demonstrates a complete response rate of 26%. This comprehensive analysis of regional therapies used for the limb is the result of collaboration, science, and persistent efforts at centers of excellence.…”

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Isolated Limb Perfusion and Infusion for Extremity Soft Tissue Sarcoma: A Contemporary Systematic Review and Meta-Analysis

Abstract: ILP and ILI for extremity STS can be safely performed with appreciable response rates and significant limb salvage rates. Further study is needed to identify optimal treatment regimens by histology.

Cited by 51 publications

References 48 publications

Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas

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