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Neoadjuvant isolated limb perfusion in newly diagnosed untreated patients with locally advanced soft tissue sarcomas of the extremities: the Gustave Roussy experience

  • T. AssiEmail author
  • A. Cavalcanti
  • A. Le Cesne
  • M. Faron
  • J. F. Honart
  • A. Hadiji
  • O. Camuzard
  • T. Ibrahim
  • C. LePéchoux
  • O. Mir
  • S. Dumont
  • P. Terrier
  • J. Adam
  • C. Honoré
Research Article

Abstract

Background

Limb-sparing surgery in locally advanced soft tissue sarcomas (LA STS) is challenging. The aim of this study is to evaluate upfront isolated limb perfusion (ILP) in untreated patients with LA STS.

Methods

All consecutive patients with LA STS of the limbs deemed borderline or unresectable and treated with upfront ILP as induction treatment between 2003 and 2016 were included. Demographic, clinical and long-term characteristics were obtained and retrospectively analyzed.

Results

41 patients (pts), with a median age of 51 years [range 21–76], were identified (lower limb 68%, upper limb 32%). Liposarcoma and undifferentiated pleomorphic sarcoma were the most common subtypes (27% and 22%, respectively). Acute toxicities, using Wieberdink classification, were grade II (35 pts, 85%), grade III (2 pts, 5%) and no grade IV–V. Local control rate was 98%. 32 pts had limb-sparing surgery (78%). 1 pt had an early amputation due to progressive disease after ILP. 8 pts were not operated (four had RT alone, one had distant metastases, two had a complete response and one died 3 months after ILP of a pulmonary embolism). 36 pts (84%) received postoperative RT. After a median follow-up of 43 months, 18 pts (47%) relapsed. Median disease-free survival (DFS) was 6.7 years. The median overall survival (OS) was not reached. The 1-year, 5-year and 10-year DFS and OS rates were, respectively, 75%, 50% and 45%, and 90%, 63% and 55%.

Conclusion

Upfront ILP is an efficient and well-tolerated limb-sparing procedure in borderline or unresectable LA STS without hampering OS.

Keywords

Isolated limb perfusion Soft tissue sarcoma Neoadjuvant treatment Chemotherapy Limb salvage 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

An approval of the institutional ethics board at Gustave Roussy was obtained.

Research involving human participants and/or animals

Not applicable.

Informed consent

Not applicable.

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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2019

Authors and Affiliations

  • T. Assi
    • 1
    Email author
  • A. Cavalcanti
    • 2
  • A. Le Cesne
    • 1
  • M. Faron
    • 2
  • J. F. Honart
    • 2
  • A. Hadiji
    • 2
  • O. Camuzard
    • 1
  • T. Ibrahim
    • 1
  • C. LePéchoux
    • 3
  • O. Mir
    • 1
  • S. Dumont
    • 1
  • P. Terrier
    • 4
  • J. Adam
    • 4
  • C. Honoré
    • 2
  1. 1.Department of Medical OncologyGustave Roussy Cancer CampusVillejuif CedexFrance
  2. 2.Department of Surgical OncologyRoussy Cancer Campus GustaveVillejuifFrance
  3. 3.Department of Radiation TherapyGustave Roussy Cancer CampusVillejuifFrance
  4. 4.Department of PathologyGustave Roussy Cancer CampusVillejuifFrance

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