Isolated limb perfusion for undifferentiated pleomorphic sarcoma treatment

Abstract

Background: Soft tissue sarcomas constitute 1% of adult malignant tumors. One of treatment possibilities is isolated limb perfusion (ILP). This procedure involves surgical isolation of vascular inflow and outflow of an extremity to separate circulation of affected limb from remained body. Thus, high concentrations of drugs can be circulated locally without exposing the rest of the body to the same level of toxicity. Case report: In September 2019, a 52 year-old man had complained about left proximal calf pain which had been lasting for two years (intensively for 1 week). Anamnesis indicated non-Hodgkin lymphoma (21 years ago). Computer tomography and magnetic resonance imaging (MRI) had resulted left calf local malignant tumor. Performed biopsy had showed high malignancy tumor - most likely to undifferentiated pleomorphic sarcoma. Neoadjuvant chemotherapy had not been possible due to previous lymphoma chemotherapy treatment. Radiation therapy applied 50Gy/25 fractions. MRI – negative dynamic. In December 2019 ILP had been performed. 12Fr cannula had been inserted in V. femoralis, 14Fr in A. femoralis. Local chemotherapy with melphalan had been applied for 1 hour, tumor temperature had reached 40 degrees Celsius. After few days patient was discharged for ambulatory care. 2020-01-29 wide tumor resection (resected tumor size - 16,5x9,5x7,5cm) and knee arthroplasty with oncology knee prosthesis were performed. Tumor histopathology report - undifferentiated pleomorphic sarcoma, ypT4, status post treatment: necrosis 95%. For further treatment – rehabilitation. Presently there are no recidives or metastasis. Patient is able to walk without crutches and remains under control of the orthopedic surgeon and oncologist. Conclusions: ILP is successful for treatment of locally advanced limb soft-tissue sarcomas. By excluding the liver and kidney from the perfusion circuit, drug metabolism is minimized, thus leading to su[...].