Soft Tissue Cancer Management: Isolated Limb Infusion for Sarcoma

Abstract

<b><i>Background:</i></b> Sarcoma is a heterogeneous group of malignancies comprising almost 80 subtypes of bone and soft tissue cancers. Previously, all subtypes were managed identically. Advancements in biological and genetic studies have revealed that sarcoma subtypes display varying characteristics and therefore require tailored treatments. Locally advanced soft tissue malignancies of both the trunk and the extremities can present significant challenges for treatment. At present, a negative surgical resection margin is the only definitive treatment despite attempts to use neoadjuvant and adjuvant therapies. In patients with locally advanced non-resectable soft tissue sarcoma (STS), the current practice would advocate amputation. However, studies suggest that limb salvage may be possible with radiotherapy or regional chemotherapy using isolated limb perfusion or isolated limb infusion (ILI). An ideal treatment modality for non-resectable STS would strive for preservation of anatomy and functionality as well as improve quality of life. The aim of the study was to investigate the efficacy of isolated limb infusion as an alternative treatment modality for non-resectable locally advanced STS. <b><i>Methods:</i></b> The efficacy of ILI was retrospectively investigated in 10 patients with STS. All patients received ILI with melphalan and actinomycin at the North Estonia Medical Centre Foundation, Tallinn, Estonia from September 1, 2014 to May 31, 2018. The procedures were performed in a lower extremity in 8 patients and in an upper extremity in 2 patients. The 6-month overall response rate was 78% and the overall limb salvage rate was 100%. The distant metastatis-free survival was longer for responders than for non-responders. <b><i>Results and Conclusions:</i></b> ILI is an alternative treatment modality for regional disease control and limb preservation in patients with cutaneous and soft tissue malignant neoplasms of the extremities. The short-term response rates are encouraging and the median overall survival shows good results in this highly complex patient population.

Isolated Limb Infusion for Limb-Threatening, Unresectable Sarcoma: Past Progress, Current Applications, and Future Directions

“…Perhaps in looking forward, we should look to the past and reconsider the role of neoadjuvant ILI in high-risk and borderline-resectable STS. Additionally, 2 of the patients recently reported by Teras et al received ILI in the adjuvant setting following resection of disease [ 26 ]. Though outcomes specific to those patients were not reported, the use of ILI as adjuvant therapy in resected STS is worth additional consideration.…”

“…Another single-institution series by Teras et al in 2019 reported the retrospective outcomes of 10 patients who underwent ILI with melphalan and actinomycin D for unresectable, locally advanced STS from 2014 to 2018 [ 26 ]. At 3 months, ORR was 100% with CR in 30% of patients.…”