Professor Peter Hohenberger, of the Department of Surgical Oncology, Humboldt University of Berlin, reported that isolated limb perfusion1 had saved the limbs of 44 (88 %) out of 51 patients with locally advanced soft tissue tumours (sarcomas).
Traditional treatment has involved partial or whole amputation of affected limbs to prevent the disease from spreading. Systemic 2 chemotherapy could have been used to shrink the tumour, but would also have damaged healthy tissue.
The novel technique bypasses this problem by cutting off the blood supply to the affected limb from the general circulation and linking it to a heart-lung machine to provide oxygen and hyperthermia to healthy and malignant tissue.
High doses of cytokines and chemotherapy are then given to the affected limb at doses 10 to 20 fold higher than could be used through peripheral veins. This comprises tumour necrosis factor (TNF)-alpha and melphalan, a combination introduced by Lejeune.3 TNF-alpha, an immune system messenger prepared by gene technology, works in conjunction with agents, such as melphalan, that are toxic to cancerous cells.
The two agents probably act in synergy. Melphalan may stunt the growth of the cancerous tissue, while TNF-alpha significantly interferes with its blood supply. The more the tumour is shrunk, the more favourable are the results of tumor removal by surgery that follows the perfusion procedure six to eight weeks later. Radical resection (removal) of the residual tumor offers the chance of saving the limb.
Professor Hohenberger told the meeting: "Pre-operative isolated limb perfusion combined with an aggressive surgical approach results in an excellent local control rate in high grade soft tissue sarcoma. Long term limb salvage can be achieved in the overwhelming majority of our patients."
A thorough post-surgical survey using validated questionnaires showed that the patients were able to maintain more than 80 per cent of their pre-operative activities.
Abstract No. 115