Isolated limb perfusion for the management limb threatening soft tissue sarcomas: The role of histological type on clinical outcomes

Marco Rastrelli, Simone Mocellin, R. Stramare, Antonella Brunello, Marco Maruzzo, Umberto Basso, Giovanni Scarzello, M. S. Buzzaccarini, P. Pilati, L. M. Saadeh, Santo Paolo Del Fiore, Anna Lisa Tosi, Maria Montesco, L. G. Campana, Saveria Tropea, C. R. Rossi

Research output: Contribution to journalArticle

Abstract

Background: Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. Methods: This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS). Results: On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7% vs 66/84, 78.6%, P-value: 0.048; mean histological necrosis: 83.6% vs 52.9%, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1% vs 62/84, 73.8%, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009). Conclusions: HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process.

Original languageEnglish
Pages (from-to)401-6
Number of pages6
JournalEuropean Journal of Surgical Oncology
Volume43
Issue number2
Early online dateNov 18 2016
DOIs
Publication statusPublished - Feb 2017

Fingerprint

Sarcoma
Extremities
Perfusion
Liposarcoma
Leiomyosarcoma
Disease-Free Survival
Survival
Neoplasms
Neoadjuvant Therapy
Neurilemmoma
Amputation
Patient Selection
Histology
Necrosis

Keywords

  • Hyperthermia
  • Liposarcoma
  • Melphalan
  • Perfusion
  • Tumor necrosis factor

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{fdfb713b5a4c49d69a3c927c89f6f1bf,
title = "Isolated limb perfusion for the management limb threatening soft tissue sarcomas: The role of histological type on clinical outcomes",
abstract = "Background: Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. Methods: This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS). Results: On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7{\%} vs 66/84, 78.6{\%}, P-value: 0.048; mean histological necrosis: 83.6{\%} vs 52.9{\%}, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1{\%} vs 62/84, 73.8{\%}, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009). Conclusions: HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process.",
keywords = "Hyperthermia, Liposarcoma, Melphalan, Perfusion, Tumor necrosis factor",
author = "Marco Rastrelli and Simone Mocellin and R. Stramare and Antonella Brunello and Marco Maruzzo and Umberto Basso and Giovanni Scarzello and Buzzaccarini, {M. S.} and P. Pilati and Saadeh, {L. M.} and {Del Fiore}, {Santo Paolo} and Tosi, {Anna Lisa} and Maria Montesco and Campana, {L. G.} and Saveria Tropea and Rossi, {C. R.}",
year = "2017",
month = "2",
doi = "10.1016/j.ejso.2016.09.021",
language = "English",
volume = "43",
pages = "401--6",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "2",

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TY - JOUR

T1 - Isolated limb perfusion for the management limb threatening soft tissue sarcomas

T2 - The role of histological type on clinical outcomes

AU - Rastrelli, Marco

AU - Mocellin, Simone

AU - Stramare, R.

AU - Brunello, Antonella

AU - Maruzzo, Marco

AU - Basso, Umberto

AU - Scarzello, Giovanni

AU - Buzzaccarini, M. S.

AU - Pilati, P.

AU - Saadeh, L. M.

AU - Del Fiore, Santo Paolo

AU - Tosi, Anna Lisa

AU - Montesco, Maria

AU - Campana, L. G.

AU - Tropea, Saveria

AU - Rossi, C. R.

PY - 2017/2

Y1 - 2017/2

N2 - Background: Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. Methods: This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS). Results: On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7% vs 66/84, 78.6%, P-value: 0.048; mean histological necrosis: 83.6% vs 52.9%, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1% vs 62/84, 73.8%, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009). Conclusions: HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process.

AB - Background: Hyperthermic isolated limb perfusion (HILP) is an effective neoadjuvant treatment to avoid amputation in patients with locally advanced extremity soft tissue sarcomas (STS). We aimed to investigate whether STS histological type plays a role in predicting clinical outcomes. Methods: This study reports a retrospective analysis of 125 patients with limb threatening STS (liposarcoma, n = 41; malignant peripheral nerve sheath tumor, n = 20; leiomyosarcoma, n = 20; miscellany, n = 44), who underwent HILP from 1990 through 2015 at our institution. The following endpoints were evaluated: tumor response (assessed by radiological imaging and histology), limb sparing rate, local progression-free survival (LPFS) and overall survival (OS). Results: On average, overall (complete + partial) tumor response was significantly greater in patients affected with liposarcoma as compared to those with other histotypes (radiological response rate: 38/41, 92.7% vs 66/84, 78.6%, P-value: 0.048; mean histological necrosis: 83.6% vs 52.9%, P < 0.0001). Limb sparing rate was also higher among patients with liposarcoma as compared to other histotypes (39/41, 95.1% vs 62/84, 73.8%, P-value: 0.005). As regards survival, LPFS was similar across tumor types, whereas OS resulted significantly worse in patients with limb leiomyosarcoma (log-rank P-value: 0.009). Conclusions: HILP is a very effective treatment modality for limb threatening STS. In our series, liposarcoma appears to be the histological type most sensitive to HILP in terms of tumor response and thus limb sparing, which might help clinicians in the patient selection process.

KW - Hyperthermia

KW - Liposarcoma

KW - Melphalan

KW - Perfusion

KW - Tumor necrosis factor

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