Abstract
BackgroundIsolated limb perfusion with TNF-alpha and melphalan (TM-ILP) in combination with complete tumor resection is an effective treatment option for non-resectable soft-tissue sarcoma of the extremities, with limb salvage rates greater than 80%. The aim of this study was to assess quality of life (QoL) after TM-ILP, also with regard to long-term survival.MethodsWe retrospectively examined 27 patients who had primarily non-resectable soft-tissue sarcoma of the leg and who had undergone TM-ILP and complete tumor resection (with limb-sparing intent) during their follow-up examinations using the Quality of Life Questionnaire (QLQ-C30) and the German Short Musculoskeletal Function Assessment (SMFA-D). The results from the QLQ-C30 were compared to the reference values for the general population, to the “all cancer patients” reference values (both reference values published by the European Organization for Research and Treatment of Cancer (EORTC)), and to the reference values of a historical amputation group from the literature. The results of the SMFA were compared with those from a reference group of healthy individuals.ResultsSurprisingly, we found that the global health status/QoL in the TM-ILP group was not significantly different from the general population or from patients with amputation, but it was higher than that of patients with cancer in general. Concerning the SMFA, we did find functional impairments in patients after TM-ILP compared to the reference group. With regard to long-term survival, we found no time-dependent deterioration in QoL for longer time intervals after treatment.ConclusionsThese results support the use of TM-ILP in limb-sparing multimodal therapy settings from a quality-of-life perspective, but they also encourage further research on this matter.
Highlights
Short Musculoskeletal Function Assessment (SMFA)-D In addition to quality of life (QoL), we aimed to provide a more precise picture of the possible dysfunctions patients experienced after TM-Isolated limb perfusion (ILP) treatment and complete tumor resection
The mean interval from TNF-melphalan-based isolated limb perfusion (TM-ILP) to participation in this study was 37 ± 26 months and ranged from 5 to 111 months
These findings seem to confirm the results found in earlier studies on the functional scales of the SF-36 [19,20,21] and indicate that (i) impairment of limb function occurs in sarcoma patients and that (ii) the functional scales of the SMFA seem less prone to the response shift phenomenon than the global health status/QoL score of the QLQ-C30
Summary
Isolated limb perfusion with TNF-alpha and melphalan (TM-ILP) in combination with complete tumor resection is an effective treatment option for non-resectable soft-tissue sarcoma of the extremities, with limb salvage rates greater than 80%. For large, primarily non-resectable STS (soft-tissue sarcoma) of the extremities, amputation still appears to be a treatment option that is regularly offered to patients, modern multidisciplinary treatment concepts could often save the patient’s limb. One of these treatment modalities is TM-ILP (TNF-melphalan-based isolated limb perfusion), which has developed into a successful treatment option for primarily non-resectable soft-tissue sarcoma of the extremities. Limb salvage rates for tumors with a primary indication for amputation or at least mutilating surgery (including the resection of major nerves and vascular structures with no adequate means of restoring limb function) are well above 80%, as reported by all high-volume centers performing TM-ILP [2,3,4,5,6,7,8]
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