Isolated limb perfusion with high-dose ifosfamide in the treatment of locally advanced sarcoma. A pilot study

Abstract

9053 Background: Recent studies have evaluated the role of isolated limb perfusion (ILP) and hyperthermia in the management of extremity sarcoma. The agents most commonly employed for ILP have been melphalan and Tumor Necrosis Factor that increase significantly the response rate. We present the initial experience with ifosfamide in regional therapy. Methods: We conducted a prospective program of ILP and include five patients with histologically proved soft tissue and osseus sarcoma. All patients included had big tumors with no other option than amputation. All perfusions were done with ifosfamide (78 gr/m2 of perfunded limb area) and mild hyperthermia (39–40°C). The leakage monitoring was performed with Tc99 radiolabelled erythrocytes with a hand held gammaprobe. The clinical, pathologic and overall response rate was recorded. Results: There were five patients (2 women, 3 men) with a median age of 41 years. The median size was 19 cm. The level of perfusion was brachial (2) for the tumors located in the arm, iliac for the tumor located in the thigh and femoral for the tumor located in the knee. The clinical response rate was assessed with MRI, CT and Doppler ultrasound. The clinical response rate (CRR) was partial in three, for an overall CRR of 75%. The median leakage was 5% (0–6%). Regional toxicity was recorded according to Wieberdink scale; all the patients develop erithema and mild edema of the extremities (Wieberdink II). No late toxicity was recorded. There was transient neuropathy in the cases with clinical and pathologic response. The resection of residual tumor was done at two and three weeks after perfusion. The percentage of necrosis was recorded (Case 1:95%, Case 2: 10%, Case 3: 70%, Case 4: 70%). The patient with osseous sarcoma had a 95% of necrosis. A limb sparing procedure was successfully done in three cases. Adjuvant radiation therapy was included in all soft tissue cases, even with near complete pathologic response. With a median follow up of 8 months (2–16 months) three patients are alive, with no evidence of disease. Conclusions: Isolated Limb Perfusion with high dose ifosfamide and mild hyperthermia is efficient therapy for locally advanced soft tissue sarcoma. No significant financial relationships to disclose.