Lower limb function and quality of life after ILP for soft-tissue sarcoma

Abstract

Background: Isolated limb perfusion with TNF-alpha and melphalan (TM-ILP) in combination with complete tumor resection is an effective treatment option for non-resectable soft-tissue sarcoma of the extremities, with limb salvage rates greater than 80%. The aim of this study was to assess quality of life (QoL) after TM-ILP, also with regard to long-term survival.

Methods: We retrospectively examined 27 patients who had primarily non-resectable soft-tissue sarcoma of the leg and who had undergone TM-ILP and complete tumor resection (with limb-sparing intent) during their follow-up examinations using the Quality of Life Questionnaire (QLQ-C30) and the German Short Musculoskeletal Function Assessment (SMFA-D). The results from the QLQ-C30 were compared to the reference values for the general population, to the "all cancer patients" reference values (both reference values published by the European Organization for Research and Treatment of Cancer (EORTC)), and to the reference values of a historical amputation group from the literature. The results of the SMFA were compared with those from a reference group of healthy individuals.

Results: Surprisingly, we found that the global health status/QoL in the TM-ILP group was not significantly different from the general population or from patients with amputation, but it was higher than that of patients with cancer in general. Concerning the SMFA, we did find functional impairments in patients after TM-ILP compared to the reference group. With regard to long-term survival, we found no time-dependent deterioration in QoL for longer time intervals after treatment.

Conclusions: These results support the use of TM-ILP in limb-sparing multimodal therapy settings from a quality-of-life perspective, but they also encourage further research on this matter.

Keywords: Isolated limb perfusion; Limb function; Long-term survival; Melphalan; Quality of life; Soft-tissue sarcoma; TNF-alpha.

Fig. 1

Flow chart presenting the TM-ILP patient selection process

Fig. 2

Histogram displaying the distribution of overall QoL scores in the TM-ILP patient group. Overlying is the normal distribution curve

Fig. 3

Means and 95% confidence intervals comparing the QLQ-C30 function scale scores of TM-ILP patients with short-term and long-term follow-up after treatment

Fig. 4

Means and 95% confidence intervals comparing the QLQ-C30 symptom scale scores of TM-ILP patients with short-term and long-term follow-up after treatment

Fig. 5

Means and 95% confidence intervals comparing the SMFA scale scores of TM-ILP patients (patients) to those of a reference group of healthy volunteers (SMFA ref. general population). Significance was calculated with the Mann-Whitney U test and is indicated by * (p < 0.05)