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Der Onkologe

, Volume 15, Issue 4, pp 382–388 | Cite as

Isolierte Extremitätenperfusion zur lokalen Tumorkontrolle an den Gliedmaßen

  • G. Taeger
  • F. Grabellus
  • L.E. Podleska
  • S. Müller
  • S. Lendemans
Leitthema

Zusammenfassung

Die proliferativen Randzonen determinieren beim hoch malignen Weichteilsarkom (WTS) die Rezidivhäufigkeit. Bei der Resektion großer und tief lokalisierter Sarkome ist aber das Erreichen sog. weiter Sicherheitsabstände unter der Maßgabe des Erhalts von Funktion und Gliedmaße häufig limitiert. Selbst knappe Abstände können zuweilen nicht erreicht werden. Durch neoadjuvante Therapieverfahren kann mittels Devitalisierung oder Schrumpfung des Tumors eine spätere Resektion deutlich verbessert oder erst ermöglicht werden. Die isolierte Extremitätenperfusion mit TNF-α und Melphalan (TM-ILP) gilt dabei als das effektivste Therapieverfahren. Mehrere Studien berichten über Remissionsraten von bis zu 80% mit Verbesserung der späteren Resektion und Erhalt von Funktion und Gliedmaße. Einen besonders hohen Stellenwert besitzt die TM-ILP für Patienten mit synchron metastasierten großen WTS der Gliedmaßen. Im Gegensatz zu den zeitlichen Verzögerungen, die meist mit den ausgedehnten chirurgischen Resektionen verbunden sind, kann nach TM-ILP schon innerhalb weniger Tage die Systemtherapie erfolgen. Diese Therapiemodalität sollte in tertiären Behandlungszentren angeboten werden können.

Schlüsselwörter

Weichteilsarkom Isolierte Extremitätenperfusion TNF-α Regression Gliedmaßenerhalt 

Isolated limb perfusion for local tumor control and limb salvage

Abstract

Clear and wide safety margins are required in surgical resections of high-grade soft tissue sarcomas (STS) due to the proliferation patterns at the periphery of the tumors. But resections of large and deep-seated tumors are often limited by close or even marginal resection margins in order to salvage a limb and its function. Hence, neoadjuvant treatment strategies may improve subsequent surgical resection by shrinking and devitalizing the local tumor. Of these treatment modalities, hyperthermic isolated limb perfusion with TNF-α and melphalan (TM-ILP) provides the most effective deterioration of advanced and even nonresectable STS by immediate destruction of the vasculature. Different studies have reported remission rates of up to 80%, with improved subsequent resection as well as minimization of the surgical trauma usually associated with the resection of high-grade sarcomas. Obviously, TM-ILP has its greatest potential in advanced STS of the limbs with concomitant metastatic disease. Patients are ready for systemic treatment strategies within days of deterioration of the local tumor by TM-ILP. This treatment modality should be offered to these patients and should be available in tertiary cancer centers.

Keywords

Soft Tissue Sarcoma Isolated limb perfusion TNF-α Regression Limb salvage 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • G. Taeger
    • 1
  • F. Grabellus
    • 1
  • L.E. Podleska
    • 1
  • S. Müller
    • 1
  • S. Lendemans
    • 1
  1. 1.Sarkomzentrum am Westdeutschen TumorzentrumUniversitätsklinikum EssenEssenDeutschland

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