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Clinical Sarcoma Research
Published in: Clinical Sarcoma Research 1/2018

Open Access 01-12-2018 | Research

Regional chemotherapy by isolated limb perfusion prior to surgery compared with surgery and post-operative radiotherapy for primary, locally advanced extremity sarcoma: a comparison of matched cohorts

Authors: Jens Jakob, Henry G. Smith, Michelle J. Wilkinson, Tim Pencavel, Aisha B. Miah, Joseph M. Thomas, Per-Ulf Tunn, Lothar R. Pilz, Dirk C. Strauss, Peter Hohenberger, Andrew J. Hayes

Published in: Clinical Sarcoma Research | Issue 1/2018

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Abstract

Background

Induction chemotherapy by isolated limb perfusion (ILP) with melphalan and tumour necrosis factor-α is an effective strategy to facilitate limb-conserving surgery in locally advanced extremity sarcoma. In a comparison of cohorts matched for grade, size and surgical resectability, we compared the outcome of patients undergoing induction ILP prior to limb-conserving surgery and selective post-operative radiotherapy with patients undergoing limb-conserving surgery and routine post-operative radiotherapy.

Methods

Patients with primary, grade 2/3 sarcomas of the lower limbs over 10 cm in size were identified from prospectively maintained databases at 3 centres. Patients treated at a UK centre underwent limb-conserving surgery and post-operative radiotherapy (Standard cohort). Patients at two German centres underwent induction ILP, limb-conserving surgery and selective post-operative radiotherapy (ILP cohort).

Results

The Standard cohort comprised 80 patients and the ILP cohort 44 patients. Both cohorts were closely matched in terms of tumour size, grade, histological subtype and surgical resectability. The median age was greater in the Standard vs the ILP cohort (60.5 years vs 56 years, p = 0.033). The median size was 13 cm in both cohorts. 5-year local-recurrence (ILP 12.2%, Standard 20.1%, p = 0.375) and distant metastases-free survival rates (ILP 49.6%, Standard 46.0% p = 0.821) did not differ significantly between cohorts. Fewer patients received post-operative radiotherapy in the ILP cohort compared with the Standard cohort (27% vs 82%, p < 0.001).

Conclusion

In comparative cohorts, the outcomes of patients undergoing induction ILP prior to surgery did not differ from those undergoing standard management, although induction ILP was associated with a reduced need for adjuvant radiation.
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Metadata
Title
Regional chemotherapy by isolated limb perfusion prior to surgery compared with surgery and post-operative radiotherapy for primary, locally advanced extremity sarcoma: a comparison of matched cohorts
Authors
Jens Jakob
Henry G. Smith
Michelle J. Wilkinson
Tim Pencavel
Aisha B. Miah
Joseph M. Thomas
Per-Ulf Tunn
Lothar R. Pilz
Dirk C. Strauss
Peter Hohenberger
Andrew J. Hayes
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Clinical Sarcoma Research / Issue 1/2018
Electronic ISSN: 2045-3329
DOI
https://doi.org/10.1186/s13569-018-0098-6

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