Annals of Surgical Oncology

, Volume 16, Issue 12, pp 3350–3357 | Cite as

Hyperthermic Isolated Limb Perfusion in Locally Advanced Soft Tissue Sarcoma and Progressive Desmoid-Type Fibromatosis with TNF 1 mg and Melphalan (T1-M HILP) Is Safe and Efficient

  • Sylvie Bonvalot
  • Françoise Rimareix
  • Sylvain Causeret
  • Cécile Le Péchoux
  • Bérénice Boulet
  • Philippe Terrier
  • Axel Le Cesne
  • Jane Muret
Bone and Soft Tissue Sarcomas



In a prior randomized phase II trial comparing hyperthermic isolated limb perfusion (HILP) with four different doses of tumor necrosis factor alpha (TNF-α), no dose effect was detected for response, but systemic toxicity was far lower with low-dose TNF-α. The objective of the present study was to confirm these data on a larger sample size of locally advanced or recurrent extremity soft tissue sarcomas with low-dose TNF-α.


We assessed a prospective database comprising 100 HILP (38–40°C) with melphalan (10 mg/L) and TNF-α (1 mg). The remnant tumor was resected 2 months later.


Among 52 recurrences, 18 were in a previously irradiated field. Stages according to the American Joint Committee on Cancer classification were II (19 patients), III (78 patients), and IV (3 patients). The site/size were: 30 patients/57 mm and 70 patients/86 mm for the upper and lower limbs, respectively. Tumor grades (FNCLCC) were 1 (23 patients), 2 (34 patients), and 3 (43 patients). Fifty-one patients had received systemic chemotherapy before HILP. Responses on magnetic resonance imaging were 30% complete, 49% partial, 9% no change, and 12% progression. No mortality or systemic toxicity occurred. Local toxicity (Wieberdink) attained grade 2 (16 patients), 3 (5 patients), and 4 (1 patient). Limbs were able to be saved in 87% patients. Three-year overall survival and the local recurrence rate were 89% and 18%, respectively. Age, sex, tumor size, recurrence, uni- or multifocality, grade, preoperative chemotherapy, and a previously irradiated field were not predictive of response or local toxicity.


We confirm that 1 mg of TNF-α is as effective as the standard dose and results in no systemic toxicity.


Local Recurrence Rate Limb Salvage Spin Echo Isolate Limb Perfusion Local Toxicity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Lorna Saint Ange for editing.


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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Sylvie Bonvalot
    • 1
  • Françoise Rimareix
    • 1
  • Sylvain Causeret
    • 1
  • Cécile Le Péchoux
    • 2
  • Bérénice Boulet
    • 3
  • Philippe Terrier
    • 4
  • Axel Le Cesne
    • 5
  • Jane Muret
    • 6
  1. 1.Department of SurgeryInstitut Gustave RoussyVillejuif CedexFrance
  2. 2.Department of RadiotherapyInstitut Gustave RoussyVillejuif CedexFrance
  3. 3.Department of RadiologyInstitut Gustave RoussyVillejuif CedexFrance
  4. 4.Department of PathologyInstitut Gustave RoussyVillejuif CedexFrance
  5. 5.Department of Medical OncologyInstitut Gustave RoussyVillejuif CedexFrance
  6. 6.Department of Anesthesia and Intensive CareInstitut Gustave RoussyVillejuif CedexFrance

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