Neoadjuvant Hypertermic Isolated Limb Perfusion in Treatment of Undifferentiated Spindle Cell Sarcoma of Lower Limb with Achieved Complete Pathologic Response
Authors:
M. Vočka 1; M. Špaček 2; Z. Matějovský 3; J. Trnka 4; G. Hodková 2; D. Skibová 4; D. Zogala 4; J. Lindner 2; L. Petruželka 1
Authors‘ workplace:
Onkologická klinika 1. LF UK a VFN v Praze
1; II. chirurgická klinika kardiovaskulární chirurgie 1. LF UK a VFN v Praze
2; Ortopedická klinika 1. LF UK a Nemocnice Na Bulovce, Praha
3; Ústav nukleární medicíny, 1. LF UK a VFN v Praze
4
Published in:
Klin Onkol 2019; 32(3): 211-213
Category:
Case Report
doi:
https://doi.org/10.14735/amko2019211
Overview
Background: Hyperthermic isolated limb perfusion uses therapeutic effect of hyperthermia in the bounded compartment of the limb together with increased concentration of chemotherapy effect than what would be achieved in systemic application. Gold standard was melphalan (Alkeran) in combination with tasonermin (Beromun, tumor necrosis factor alpha). The efficacy of this combination has been demonstrated in limb soft tissue sarcomas and in patients with limb isolated bulky disease of malignant melanoma.
Case: We describe a case of a 65-year-old female patient with undifferentiated spindle-cell sarcoma treated by a multidisciplinary team at the 2nd Surgical Clinic of Cardiovascular Surgery and Clinic of Oncology General University Hospital in Prague and at the Department of Orthopaedics Na Bulovce Hospital with the aim of preserving the limb despite the advanced disease. The patient underwent hyperthermic isolated limb perfusion with tasonermin and melphalan with partial response on magnetic resonance imaging. Subsequent wide resection was done with complete pathological remission according to histological examination maintaining a fully functional limb. The patient is followed without signs of recurrence.
Conclusion: Hyperthermic isolated limb perfusion with tasonermin and melphalan is an important part of a multimodal approach in the treatment of extremity sarcomas with a high percentage of responses that increase the percentage of limbs retaining resections. Multidisciplinary team should consider this option in patients with localized limb sarcomas and should be performed in specialized centers with experience in this procedure.
This work was supported by project Progres Q28-LF1.
The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.
The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
Keywords:
hypertermic isolated perfusion – soft tissue sarcoma – lower limb – complete remission – tasonermin
Sources
1. Creech O Jr, Krementz ET, Ryan RF et al. Chemotherapy of cancer: regional perfusion utiliz ing an extracorporeal circuit. Ann Surg 1958; 148 (4): 616–632.
2. Eggermont AM, Schrafordt Koops H, Klausner JM et al. Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience. Ann Surg 1996; 224 (6): 756–765.
3. Taeger G, Grabellus F, Podleska LE et al. Effectiveness of regional chemotherapy with TNF-alpha/melphalan in advanced soft tis sue sarcoma of the extremities. Int J Hyperthermia 2008; 24 (3): 193–203. doi: 10.1080/ 02656730701868387.
4. Moreno-Ramirez D, de la Cruz-Merino L, Ferrandiz L et al. Isolated limb perfusion for malignant melanoma: systematic review on ef fectiveness and safety. Oncologist 2010; 15 (4): 416–427. doi: 10.1634/ theoncologist.2009-0325.
5. Bergel F, Stock JA. Cytotoxic alpha amino acids and endopeptidase. Br Emp Cancer Comp Annu 1953; 31: 6–21.
6. Sarosy G, Leyland-Jones B, Soochan P et al. The systemic administration of intravenous melphalan. J Clin Oncol. 1988; 6 (11): 1768–1782. doi: 10.1200/JCO.1988.6.11. 1768.
7. Green S, Chiasson MA, Shah RG. Evidence for the presence of an antitumor factor in serum of normal animals. Cancer Lett 1979; 6 (4–5): 235–240.
8. Eggermont AM, Schrafordt Koops H, Klausner JM et al. Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tis sue extremity sarcomas. The cumulative multicenter European experience. Ann Surg 1996; 224 (6): 756–765.
9. Fraker DL, Alexander HR, Ross M et al. A phase III trial of isolated limb perfusion for extremity melanoma comparing melphalan alone versus melphalan plus tumor necrosis factor (TNF) plus interferon-gamma (IFN). Ann Surg Oncol 2002; 9 (1): S8.
10. Špaček M, Petruželka L, Lacina L et al. Tasonermin jako součást izolované perfuze končetin. Farmakoterapie 2011; 5. [online]. Dostupné z: http: //www.prolekare.cz/farmakoterapie-clanek/tasonermin-jako-soucast-izolovane-perfuze-koncetin-36816.
11. Špaček M, Mitáš P, Vočka M et al. Isolated Perfusion of the Upper Extremity with TNF-α – Double Venous Cannulation. Klin Onkol 2017; 30 (3): 213–219. doi: 10.14735/amko2017213.
12. Trnka J, Špaček M, Šírová V et al. Hypertermická izolovaná perfuze končetin v kombinaci s tasonerminem – technika monitorování úniku perfuzátu. Klin Onkol 2016; 29 (5): 375–379. doi: 10.14735/ amko2016 375.
13. NCCN Clinical Practise Guidlines in Oncology. [online]. Dostupné z: www.nccn.org.
14. Issels RD, Lindner LH, Verweij J. Neo-adjuvant chemotherapy alone or with regional hyperthermia for localised high-risk soft-tissue sarcoma: a randomised phase 3 multicentre study. Lancet Oncol 2010; 11 (6): 561–570. doi: 10.1016/S1470-2045 (10) 70071-1.
15. Gronchi A, Ferrari S, Quaqliuolo V et al. Histotype-tailored neoadjuvant chemotherapy versus standard chemotherapy in patients with high-risk soft-tissue sarcomas (ISG-STS 1001): an international, open-label, randomised, controlled, phase 3, multicentre trial. Lancet Oncol 2017; 18 (6): 812–822. doi: 10.1016/S1470-2045 (17) 30 334-0.
16. Palassini E, Ferrari S, Verderio P et al. Feasibility of Preoperative chemotherapy with or without radiation therapy in localized soft tissue sarcomas of limbs and superficial trunk in the Italian Sarcoma group/grupo Espanol de investigacion en Sarcomas randomized clinical trial: three versus five cycles of full-dose epirubicin plus ifosfamide. J Clin Oncol 2015; 33 (31): 3628–3634. doi: 10.1200/JCO.2015.62.9394.
17. Haas RL, Delaney TF, O‘Sullivan B et al. Radiotherapy for management of extremity soft tissue sarcomas: why, when, and where? Int J Radiat Oncol Biol Phys 2012; 84 (3): 572–580. doi: 10.1016/j.ijrobp.2012.01.062.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2019 Issue 3
Most read in this issue
- Current FIGO Staging for Carcinoma of the Cervix Uteri and Treatment of Particular Stages
- Rhabdomyosarcoma of the Gluteus Maximus – Case Report, Review of Literature and Emerging Therapeutic Targets
- Prevalence of Anxiety and Depression and Their Impact on the Quality of Life of Cancer Patients Treated with Palliative Antineoplasic Therapy – Results of the PALINT Trial
- The Loneliness of Patients in the Pre-Terminal and Terminal Stages of Cancer, the Social Dimension of Dying