TNF-based isolated limb perfusion in unresectable extremity desmoid tumours

Area of Science:

• Oncology
• Surgical Oncology
• Pharmacology

Background:

• Desmoid tumors are aggressive soft tissue sarcomas with high local recurrence rates.
• Local aggressiveness can preclude limb-sparing surgery, leading to severe disability.
• Isolated limb perfusion (ILP) with TNF and melphalan is effective for soft tissue sarcomas.

Purpose of the Study:

• To evaluate the efficacy of ILP with TNF and melphalan for locally advanced extremity desmoid tumors.
• To assess the potential of ILP in cases where limb-preserving surgery is not feasible.

Main Methods:

• A prospective database analysis of 12 ILP procedures in 11 patients with locally advanced desmoid tumors (1991-2003).
• ILP performed with 4-3mg TNF and 10-13 mg/l limb volume melphalan for leg and arm perfusions.
• Patients had large, multifocal, recurrent, or extensively pre-treated tumors, making limb preservation impossible.

Main Results:

• An overall response rate of 75% (17% complete, 58% partial response).
• Amputation was avoided in all patients.
• 100% local tumor control achieved, with two cases requiring repeat ILP or systemic chemotherapy.
• Mild local toxicity and no systemic toxicity observed.

Conclusions:

• ILP is a highly effective component of multimodality treatment for limb desmoid tumors.
• Consider ILP for aggressive, disabling desmoid tumors where limb-sparing resection is impossible without significant functional compromise.