Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis

D. L M Van Broekhoven, J. P. Deroose, S. Bonvalot, A. Gronchi, D. J. Grünhagen, A. M M Eggermont, C. Verhoef

Research output: Contribution to journalArticle

Abstract

Background: Aggressive fibromatoses (desmoid tumours) may be locally aggressive, but do not metasta-size. Although a conservative approach is advocated for most patients, pain and functional impairment are indications for active treatment. Tumour necrosis factor (TNF) α and melphalan-based isolated limb perfusion (TM-ILP) is a limb-saving treatment modality for soft tissue tumours. This study reports the results of TM-ILP treatment in patients with aggressive fibromatosis.

Methods: Institutional databases of three European centres were searched. All patients who received TM-ILP treatment for aggressive fibromatosis between 1990 and 2012 were included. Before therapy, the patients were discussed at multidisciplinary tumour board meetings.

Results: Twenty-five patients received 28 TM-ILP treatments. The median age of patients was 28 (i.q.r. 19-34) years and median hospital stay was 8 (7-12) days. Median follow-up was 84 (34-114) months. A complete response was achieved after two TM-ILP treatments, and a partial response after 17 treatments in 16 patients. Stable disease was reported after eight treatments in seven patients, including a patient with stable disease after the first treatment and progression after the second TM-ILP. Toxicity was modest after most treatments; Wieberdink grade IV (extensive epidermolysis, and threatening or manifest compartment syndrome) was seen after two TM-ILP treatments. Systemic leakage was reported after one treatment, but did not lead to systemic toxicity. Functional outcome was good; 16 patients had no physical limitations, and six patients had some limitations but did not need medical aids. Amputation was prevented in all but three patients.

Conclusion: TNF-α-based ILP is effective in patients with aggressive fibromatosis.

Original languageEnglish
Pages (from-to)1674-1680
Number of pages7
JournalBritish Journal of Surgery
Volume101
Issue number13
DOIs
Publication statusPublished - Dec 1 2014

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Aggressive Fibromatosis
Melphalan
Extremities
Tumor Necrosis Factor-alpha
Perfusion
Therapeutics
Compartment Syndromes
Neoplasms
Amputation

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Van Broekhoven, D. L. M., Deroose, J. P., Bonvalot, S., Gronchi, A., Grünhagen, D. J., Eggermont, A. M. M., & Verhoef, C. (2014). Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis. British Journal of Surgery, 101(13), 1674-1680. https://doi.org/10.1002/bjs.9659

Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis. / Van Broekhoven, D. L M; Deroose, J. P.; Bonvalot, S.; Gronchi, A.; Grünhagen, D. J.; Eggermont, A. M M; Verhoef, C.

In: British Journal of Surgery, Vol. 101, No. 13, 01.12.2014, p. 1674-1680.

Research output: Contribution to journalArticle

Van Broekhoven, DLM, Deroose, JP, Bonvalot, S, Gronchi, A, Grünhagen, DJ, Eggermont, AMM & Verhoef, C 2014, 'Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis', British Journal of Surgery, vol. 101, no. 13, pp. 1674-1680. https://doi.org/10.1002/bjs.9659
Van Broekhoven, D. L M ; Deroose, J. P. ; Bonvalot, S. ; Gronchi, A. ; Grünhagen, D. J. ; Eggermont, A. M M ; Verhoef, C. / Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis. In: British Journal of Surgery. 2014 ; Vol. 101, No. 13. pp. 1674-1680.
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AU - Grünhagen, D. J.

AU - Eggermont, A. M M

AU - Verhoef, C.

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N2 - Background: Aggressive fibromatoses (desmoid tumours) may be locally aggressive, but do not metasta-size. Although a conservative approach is advocated for most patients, pain and functional impairment are indications for active treatment. Tumour necrosis factor (TNF) α and melphalan-based isolated limb perfusion (TM-ILP) is a limb-saving treatment modality for soft tissue tumours. This study reports the results of TM-ILP treatment in patients with aggressive fibromatosis.Methods: Institutional databases of three European centres were searched. All patients who received TM-ILP treatment for aggressive fibromatosis between 1990 and 2012 were included. Before therapy, the patients were discussed at multidisciplinary tumour board meetings.Results: Twenty-five patients received 28 TM-ILP treatments. The median age of patients was 28 (i.q.r. 19-34) years and median hospital stay was 8 (7-12) days. Median follow-up was 84 (34-114) months. A complete response was achieved after two TM-ILP treatments, and a partial response after 17 treatments in 16 patients. Stable disease was reported after eight treatments in seven patients, including a patient with stable disease after the first treatment and progression after the second TM-ILP. Toxicity was modest after most treatments; Wieberdink grade IV (extensive epidermolysis, and threatening or manifest compartment syndrome) was seen after two TM-ILP treatments. Systemic leakage was reported after one treatment, but did not lead to systemic toxicity. Functional outcome was good; 16 patients had no physical limitations, and six patients had some limitations but did not need medical aids. Amputation was prevented in all but three patients.Conclusion: TNF-α-based ILP is effective in patients with aggressive fibromatosis.

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