Treatment modifications in tumour necrosis factor-α (TNF)-based isolated limb perfusion in patients with advanced extremity soft tissue sarcomas

Background: Tumour necrosis factor-a (TNF) and melphalan based isolated limb perfusion (TM-ILP) is an attractive treatment option for advanced extremity soft tissue sar- comas (STS). This study reports on a 20-year single centre experience and discusses the evo- lution and changes in methodology since the introduction of TNF in ILP. Patients and methods: We performed 306 TM-ILPs in 275 patients with extremity STS. All patients were candidates for amputation or mutilating surgery in order to achieve local con- trol. Clinical response evaluation consisted of clinical examination and magnetic resonance imaging. To evaluate the importance of TNF-dose, treatment results of two periods (1991- 2003 high dose (3-4 mg) TNF; 2003-2012 reduced dose (1-2 mg) TNF) were compared. Results: During the study period, more femoral perfusions were done instead of iliac perfu- sions. Reduction of TNF dose and reduction of total ILP time did not lead to different clinical response rates (70% and 69% for periods 1 and 2 respectively) or different local recurrence rates, but was associated with less local toxicity (23% and 14% for periods 1 and 2 respec- tively). Hospital stay was significantly reduced during the study period. There was an improved pathological response in the high dose TNF group without consequences for clinical outcome.