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Revolutionizing the treatment of locally advanced extremity soft tissue sarcomas: a review on TNFα-based isolated limb perfusion

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

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Zusammenfassung

GRUNDLAGEN: Lokal fortgeschrittene Weichgewebssarkome der Extremitäten stellen mit dem Ziel der lokalen Tumorkontrolle und dem gleichzeitigen Funktionserhalt eine stetige operative Herausforderung dar. Die isolierte hypertherme Extremitätenperfusion mit TNFα und Melphalan ist als neoadjuvante Therapieoption eingeführt worden, um Amputationen zu vermeiden, ohne die Prognose zu verschlechtern. METHODIK: Literaturrecherche über die PubMed Datenbank mittels Entrez, kombiniert mit den Erfahrungen der Autoren. ERGEBNISSE: Anhand mehrerer Studien wurde belegt, dass durch die ILP ein Extremitätenerhalt in bis zu 80 % der Fälle bei tolerablen lokalen und systemischen Komplikationen zu realisieren ist. Die Lokalrezidivrate liegt zwischen 10–20 %. SCHLUSSFOLGERUNGEN: Die isolierte Extremitätenperfusion mit TNFα und Melphalan hat die Behandlung von lokal fortgeschrittenen Weichgewebssarkomen der Extremitäten durch eine deutliche Reduktion der Amputationsraten revolutioniert. Weitere Fortschritte können nach Einführung neuer Substanzen erwartet werden.

Summary

BACKGROUND: The treatment of locally advanced extremity soft tissue sarcoma poses a surgical challenge and may necessitate the amputation of the tumor-bearing extremity. Isolated limb perfusion with TNFα and melphalan was introduced as a neoadjuvant modality to facilitate limp-sparing surgery without influencing prognosis negatively. METHODS: Literature research of the PubMed database using Entrez, combined with the authors' experience. RESULTS: A limb salvage rate of approximately 80% and a local recurrence rate of 10–20% after delayed surgical resection have been reported and confirmed by multiple studies, with a low regional and systemic toxicity. CONCLUSIONS: TNFα-based isolated limb perfusion has revolutionized the treatment of locally advanced extremity soft tissue sarcomas. Further improvements are awaited after the introduction of new agents and novel approaches.

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  1. Sarcoma Center Berlin-Brandenburg, Department of Orthopedic Oncology, Helios Klinikum Berlin-Buch, Berlin, Germany

    D. Andreou, S. Fehlberg, C. Tiedke, M. Niethard & P. U. Tunn

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  1. D. Andreou
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  2. S. Fehlberg
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  3. C. Tiedke
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  4. M. Niethard
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  5. P. U. Tunn
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Andreou, D., Fehlberg, S., Tiedke, C. et al. Revolutionizing the treatment of locally advanced extremity soft tissue sarcomas: a review on TNFα-based isolated limb perfusion. Eur Surg 41, 176–188 (2009). https://doi.org/10.1007/s10353-009-0479-4

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