1504P - Isolated limb perfusion in locally-advanced limb soft tissue sarcomas: retrospective study of a 23-year experience

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Soft Tissue Sarcomas
Presenter Marco Rastrelli
Authors M. Rastrelli1, L.G. Campana2, A. Vecchiato1, P.L. Pilati3, S. Valpione4, R. Spina1, C. Falci5, A. Sommariva1, A. Zanon3, C.R. Rossi1
  • 1Sarcoma And Melanoma Unit, Veneto Region Oncology Research Institute (IOV-IRCCS), 35128 - Padova/IT
  • 2Veneto Region Oncology Research Institute (IOV-IRCCS), 35128 - Padova/IT
  • 3Gastroenterological And Surgical Sciences, University of Padova, 35128 - Padova/IT
  • 4University of Padova, Padova/IT
  • 5Oncologia Medica 2, Veneto Region Oncology Research Institute (IOV-IRCCS), Padova/IT

Abstract

Background

Hyperthermic isolated limb perfusion (HILP) is a cytoreductive treatment to avoid amputation in limb soft tissue sarcomas (LSTS). HILP drug schedule has been modified to balance treatment activity and toxicity.

Methods

From 1988 to 2011, 117 patients with unresectable primary or recurrent LSTS underwent HILP. Tumor characteristics, HILP parameters and drugs (doxorubicin; doxorubicin plus TNFa; TNFa plus L-PAM), postoperative plasma myoglobin, tumor response, systemic chemotherapy (CT), site of recurrence and outcome were analyzed.

Results

The 3 treatment groups were homogeneous for clinical pathological features. The tumor response (necrosis in resected specimen) was comparable (P = .473) (Table) and was correlated with myoglobin (P < .05). Locoregional toxicity was similar in the three groups (P = .233) (Table). Surgical resection was radical in 83.2% of cases. The 5-year LDFS was 70.2%, with no differences according to HILP schedule (P = .475). 22.2% of patients required limb amputation, for complications (n = 1), unresponsiveness (n = 17) or recurrence (n = 8). The amputation rate was higher in upper LSTS (P = .049). Systemic metastases occurred in 47 patients (40.2%) after a median of 14.6 months; their occurrence inversely correlated with post-HILP necrosis (P = .001). Five-year OS was 48.1%. The avoidance of amputation (P = .044), CT (P = .003) and lung as site of systemic recurrence (P = .018) were associated with longer OS. Lung metastases were predictors for longer OS in case of systemic progression (OR 3.81,95% CI 1.74-8.34,P < .001). Prognosis was not influenced by CT (P = .087).

Conclusions

Doxorubicin, doxorubicin + TNFa and TNFa + L-PAM schedules are equally active, with comparable toxicity profiles. Upper LSTS and poor post-HILP necrosis were related with higher amputation rates. Despite preserving limb function, 40% of HILP patients develop a systemic recurrence, particularly when achieving lower responses. Lung relapses lung have a relatively better prognosis.

Drug schedule Tumor necrosis, median % (range) Locoregional toxicity according to Wieberdinkn° of pts (%)
1- 2 3 4 5
DOXOn = 47 54 (7-91) 38 (80.9) 8 (17.0) 1 (2.1) 0
TNFa + DOXO n = 30 64 (10-100) 24 (80.0) 4 (13.4) 1 (3.3) 1 (3.3)
TNFa + L-PAM n = 40 57 (4-91) 37 (92.5) 1 (2.5) 2 (5.0) 0

Disclosure

All authors have declared no conflicts of interest.