Published in:
03-06-2022 | Soft Tissue Sarcoma | Point of Technique
Isolated Limb Perfusion of Upper Limb: How I Do It
Authors:
Chandra Kumar Krishnan, Punitha Arivazhagan, Anand Karnawat, Anand Raja
Published in:
Indian Journal of Surgical Oncology
|
Issue 4/2022
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Excerpt
The limb salvage rates for extremity soft tissue sarcomas (STSs) are over 90% (1, 2). Amputation however is still performed for 10% of patients. Indications include (a) locally advanced soft tissue sarcomas (LSTS) and recurrent sarcomas treated with curative intent, and (b) palliative amputations in metastatic sarcoma (3). Management of LSTS is challenging. The only upfront surgical option for them would be an amputation. Amputation undoubtedly provides the best local control rates for LSTS (4). Most patients are apprehensive and decline amputation and want their limbs preserved. Data on efficacy of neo-adjuvant radiation in downstaging LSTS to permit limb salvage is scarce. The role of chemotherapy (CT) in STS is evolving (5, 6). The response rates of CT are inferior to that of ILP. Literature review reveals isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNFα) + melphalan can salvage 50–80% of limbs in locally advanced STSs (7–11). …
