Improved survival for soft tissue sarcoma of the extremities by regional hyperthermic perfusion, local excision and radiation therapy

Abstract

Soft tissue sarcomas continue to present problems with both local control of disease and death from distant metastases after accepted surgical therapy. Multimodality management has been established in the literature to be superior to traditional therapy of wide excision or amputation. The results of the treatment of 64 patients at Oregon Health Sciences University using regional hyperthermic perfusion with l-phenylalanine mustard and actinomycin D, wide local excision and external radiation therapy are reviewed. Histologic tumor types included: 19 liposarcomas, 14 malignant fibrous histiocytomas, eight fibrosarcomas, five leiomyosarcomas, four malignant schwannomas and 14 other sarcomas of the extremities. Minimum follow-up study has been 24 months and the mean follow-up time is more than five years. One-third of the patients presented with local recurrent disease after unsuccessful primary treatment. Over-all local recurrence for all patients treated by a combination of the aforementioned modalities was 3.4 per cent at two years and 11.1 per cent at five years. The over-all survival rate for all patients was 88 per cent at two years and 67 per cent at five years compared with a published over-all five year survival rate of 41 per cent. Patients with malignant fibrous histiocytomas had both two and five year local recurrence rates of 7.7 per cent and survival rates at two and five years of 79 and 63 per cent, respectively. This is compared with a previously published over-all five year survival rate with malignant fibrous histiocytomas of 46 per cent. The results with the treatment of liposarcomas were also superior to the published literature. Not only are the treatment results with regional hyperthermic perfusions excellent for both primary and locally recurrent sarcomas of the extremities, but limbs previously considered unsalvagable can be spared.