Isolated limb perfusion in the treatment of soft tissue sarcoma: evolution, characteristics, prospects of application

It performed the analysis of literature data on development of isolated limb perfusion (ILP) in the treatment of soft tissue sarcomas (STS), its clinical efficacy and safety. The historical aspects of the method introduction into clinical practice are considered. It is noted that for more than two decades the method has been used for locally advanced limb sarcomas, unifocal tumors localized in the neurovascular bundle with invasion into the bundle or bone, tumor recurrence in previously irradiated areas without the possibility of radical resection. The technique of performing the method, drugs (melphalan and tumor necrosis factor-α) and their modes of application are described.

It was noted that systemic toxicity during ILP is directly associated with the volume of the drug entering the systemic circulation, as a rule, the value of this indicator is less than 3–4 %. Discussion issues of the criteria for the effectiveness of STS treatment are considered, it is indicated that the main result of ILP is used by most authors the criterion of the extremity rescue frequency, its value ranges from 72 to 96 %. Survival without signs of local recurrence within 5 years after ILP with melphalan/tumor necrosis factor-αand tumor resection is from 73 to 87 %. The tasks of improving ILP are described, including the need to search for combined treatment regimens for local and systemic therapy in patients who undergo this treatment. Promising directions are the improvement of forecasting tools and the creation of innovative drugs that can be used in ILP, which will contribute to a higher clinical efficacy and safety of the method in the treatment of STS.