Bone and soft tissue sarcomas, tumors of the skinBone and soft tissue sarcomas, tumors of the skinСаркомы костей, мягких тканей и опухоли кожи2219-46142782-3687Publishing House ABV Press1310.17650/2070-9781-2020-12-4-40-47SOFT TISSUE SARCOMASСАРКОМЫ МЯГКИХ ТКАНЕЙIsolated limb perfusion in the treatment of soft tissue sarcoma: evolution, characteristics, prospects of applicationМетод изолированной перфузии конечности в лечении саркомы мягких тканей: эволюция, характеристики, перспективы примененияhttps://orcid.org/0000-0001-8814-8381PetrochenkoN. S.ПетроченкоН. С.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

petrochenko_nikolayy@rambler.ruhttps://orcid.org/0000-0002-6232-1702BurovD. A.БуровД. А.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

 115478 Москва, Каширское шоссе, 24

https://orcid.org/0000-0002-1574-0082ManikayloA. E.МаникайлоА. Е.
Russian Federation

 Bld. 1, 20 Delegetskaya St., Moscow 127473

 127473 Москва, ул. Делегатская, 20, стр. 1

https://orcid.org/0000-0002-1396-3434BokhyanB. Yu.БохянБ. Ю.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

https://orcid.org/0000-0002-8135-4841KharatishviliT. K.ХаратишвилиТ. К.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

https://orcid.org/0000-0001-5920-8066MartynkovD. V.МартынковД. В.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

 115478 Москва, Каширское шоссе, 24

https://orcid.org/0000-0002-1421-8997KhumekhovZ. Yu.КумеховЗ. Ю.
Russian Federation

1 Ostrovityanova St., Moscow 117997

117997 Москва, ул. Островитянова, 1

https://orcid.org/0000-0002-8350-5842BatkaevaN. V.БаткаеваН. В.
Russian Federation

6 Miklukho-Maklaya St., Moscow 117198

117198 Москва, ул. Миклухо-Маклая, 6

N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииA.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of RussiaФДПО ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава РоссииN.I. Pirogov Russian National Research Medical University, Ministry of Health of RussiaФДПО ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииMedical Institute of the RUDN UniversityФНМО МИ Российского университета дружбы народов0611202012440470604202106042021Copyright ©; 2020, Petrochenko N.S., Burov D.A., Manikaylo A.E., Bokhyan B.Y., Kharatishvili T.K., Martynkov D.V., Khumekhov Z.Y., Batkaeva N.V.Copyright ©; 2020, Петроченко Н.С., Буров Д.А., Маникайло А.Е., Бохян Б.Ю., Харатишвили Т.К., Мартынков Д.В., Кумехов З.Ю., Баткаева Н.В.2020Petrochenko N.S., Burov D.A., Manikaylo A.E., Bokhyan B.Y., Kharatishvili T.K., Martynkov D.V., Khumekhov Z.Y., Batkaeva N.V.Петроченко Н.С., Буров Д.А., Маникайло А.Е., Бохян Б.Ю., Харатишвили Т.К., Мартынков Д.В., Кумехов З.Ю., Баткаева Н.В.https://creativecommons.org/licenses/by/4.0https://sarbon.abvpress.ru/jour/article/view/13

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.

В работе проведен анализ данных литературы об этапах развития метода изолированной перфузии конечностей (ИПК) в лечении сарком мягких тканей (СМТ), его клинической эффективности и безопасности. Рассмотрены исторические аспекты внедрения метода в клиническую практику. Отмечено, что уже более двух десятилетий метод применяется при местно-распространенных саркомах конечностей, унифокальных опухолях с локализацией в сосудисто-нервном  пучке  с  инвазией  в  пучок  или  в  кость,  рецидивах  опухоли  в  ранее  облученных  участках без возможности радикальной резекции. Описаны техника выполнения метода, лекарственные средства (мелфалан и фактор некроза опухоли α) и режимы их применения.Отмечено,  что  системная  токсичность  при  проведении  ИПК  прямо  ассоциирована  с  объемом  препарата, поступающего в системную циркуляцию, как правило, величина этого показателя составляет менее 3–4 %.Освещены дискуссионные вопросы критериев эффективности лечения СМТ, указано, что в качестве основного результата при проведении ИПК большинством авторов используется критерий частоты спасения конечностей, величина его составляет от 72 до 96 %. Выживаемость без признаков локальных рецидивов в течение 5 лет после ИПК с применением мелфалана/фактора некроза опухоли αи выполнением резекции опухоли составляет от 73 до 87 %. Сформулированы задачи совершенствования ИПК, в том числе обоснована необходимость поиска схем комбинированного лечения, локальной и системной терапии у пациентов, которым выполняется это лечение. Перспективными направлениями представляются совершенствование инструментов прогнозирования и создание инновационных препаратов,  которые  могут  быть  использованы  при  ИПК,  что  будет  способствовать  более  высокой  клинической эффективности и безопасности метода в лечении СМТ.

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