Hyperthermic isolated limb perfusion chemotherapy as an adjunctive therapy for soft tissue sarcomas：twelve cases of report
ZHU Xiao-jun
SONG Jian-min
LI Jing
FU Lai-hua
HU Qing-feng
Abstract：Objective To investigate the effects of preoperative hyperthermic isolated limb perfusion ( HILP ) chemotherapy as an adjunctive therapy for locally advanced soft tissue sarcomas of the limbs.Methods From January 2002 to June 2013, 12 patients with soft tissue sarcomas of the limbs ( stage II B ) underwent HILP chemotherapy. The primary lesions were removed at 14-21 days after the chemotherapy, and pathological examination was carried out. The adjunctive chemotherapy with the combination of epirubicin and ifosfamide ( AI ) was performed on 11 patients for 6 cycles after the operation. One patient was treated with local radiotherapy. Pain, swelling and changes of primary lesions in the limbs were observed and recorded after HILP chemotherapy. All the patients were followed up. The postoperative outcomes, local recurrences, metastases, complications and toxicity of chemotherapy were documented. The effects of HILP chemotherapy were evaluated according to the degree of tumor necrosis. The biochemical test was carried out to detect the changes of hepatic function and renal function. The toxicity of chemotherapy was graded according to Wieberdink et al.Results Limb swelling and increased skin temperature were noticed in 12 patients at 2 days after HILP chemotherapy, which peaked at 7-10 days after the chemotherapy. At 10 days after the chemotherapy, swelling disappeared and skin temperature was gradually decreased. Tumor reduction, increased mobility of the skin and diminished limb circumference to different degrees were found in primary lesions at 2 weeks after the chemistry.Elevation of aminopherase to different degrees was noticed in the patients at 3 days after the chemistry, which was not beyond 4 times of its normal upper limit value. Abnormal changes of the renal function were not detected. The tumor necrosis rate was 91%-100% in 5 patients ( 41.67% ), 61%-90% in 5 patients ( 41.67% ) and 0%-60% in 2 patients ( 16.66% ). All the 12 patients were followed up for a mean period of ( 27.25±37.71 ) months. Complete response ( CR ) was achieved in 1 patient, and partial response ( PR ) in 5 patients. The overall response ( OR ) rate was 50%. There were 5 cases of metastases and 2 cases of local recurrences and amputation. The local recurrence ( LR ) rate was 16.66%, and the limb salvage ( LS ) rate was 83.34%. Contracture of Achilles tendon was noticed in 1 patient, who underwent Achilles tendon lengthening and recovered well. Muscular venous thrombosis was found in 1 patient, who was treated with thrombolytic therapy and got fully recovered. Toxicity of the procedure was mild ( Wieberdink I-III ), and there was no Wieberdink IV and Wieberdink V.Conclusions As a preoperative adjuvant therapy, the HILP chemotherapy is an effective method in the treatment of soft tissue sarcomas of the limbs. It can signiifcantly kill tumor cells, reduce the local recurrence rate and improve the prognoses of the patients, with less side effects and higher safety. It plays an important role in limb salvage for the patients with locally advanced soft tissue sarcomas.
Keywords：Chemotherapycancerregional perfusionSoft tissue neoplasmsSarcomaExtremitiesPerfusion
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 10-14 )