Evaluation of 47 Soft Tissue Sarcoma Resection Specimens after Isolated Limb Perfusion with TNF-α and Melphalan: Histologically Characterized Improved Margins Correlate with Absence of Recurrences
- 6 January 2009
- journal article
- research article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 16 (3), 676-686
- https://doi.org/10.1245/s10434-008-0277-4
Abstract
Background Isolated limb perfusion (TM-ILP) is an effective limb-sparing treatment for primarily nonresectable soft tissue sarcomas (STS). Surgical margins of STS after ILP were yet not systematically studied. Methods In 47 patients with nonresectable STS, TM-ILP with subsequent tumor resection was performed. Surgical margins were systematically analyzed by light microscopy using the TNM and the Enneking classification. Furthermore, margins were analyzed for tumor regression in terms of improved resectability. Results were correlated with clinical and pathological parameters. Results Of 47 STS, 44 were classified as high-grade (93.6%) with a median tumor size of 10.0 cm. Primary limb-salvage rate was 85.1%. According to TNM resection margins were complete in 70.2% (R0) and incomplete in 29.8% (R1 = 21.3%, R2 = 8.5%). According to Enneking, 27.7% intralesional, 42.6% marginal, 21.3% wide, 2.1% radical, and 6.4% unclassifiable margins were found. Prior surgery and/or radiotherapy significantly decreased margin quality. Ten patients with incomplete resection (three intralesional, seven marginal) had no viable tumor at the plane of dissection, which was designated as “improved margins.” Whereas those patients remained relapse free, five patients with viable tumor (not improved margins) at the resection margin had local recurrences. Poor margins were associated with local and distant recurrences and limited disease-specific survival. Conclusion TM-ILP is effective for achieving limb salvage. Histopathology of surgical margins demonstrates cases with so-called “improved margins” after TM-ILP, which are related to a better outcome even in intralesionally resected tumors. Improvement of margins should be further evaluated as a potential relevant prognostic parameter.Keywords
This publication has 42 references indexed in Scilit:
- Efficacy of high vs low dose TNF-isolated limb perfusion for locally advanced soft tissue sarcomaEuropean Journal of Surgical Oncology, 2009
- Isolated Limb Perfusion with Tumor Necrosis Factor Alpha and Melphalan for Locally Advanced Soft Tissue Sarcoma: Three Time Periods at Risk for AmputationAnnals of Surgical Oncology, 2007
- Advanced Extremity Soft Tissue Sarcoma: Prognostic Effect of Isolated Limb Perfusion in a Series of 88 Patients Treated at a Single InstitutionAnnals of Surgical Oncology, 2006
- Measures of Response: RECIST, WHO, and New AlternativesJournal of Clinical Oncology, 2006
- SURGICAL MARGIN AND ITS INFLUENCE ON SURVIVAL IN SOFT TISSUE SARCOMAAnz Journal of Surgery, 2006
- Isolated limb perfusion with tumor necrosis factor‐α and melphalan for patients with unresectable soft tissue sarcoma of the extremitiesCancer, 2003
- Surgical margins, local recurrence and metastasis in soft tissue sarcomasEuropean Journal Of Cancer, 2000
- Hyperthermic Isolated Limb Perfusion With Tumor Necrosis Factor-? and Melphalan in Advanced Soft-Tissue Sarcomas: Histopathological ConsiderationsAnnals of Surgical Oncology, 2000
- Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcomaCancer, 1999
- Limb-preserving treatment for soft tissue sarcomas of the extremities. The significance of surgical marginsCancer, 1993