This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis. BJS 2014; 101: 1674-1680.

Published: 9th October 2014

Authors: D. L. M. van Broekhoven, J. P. Deroose, S. Bonvalot, A. Gronchi, D. J. Grünhagen, A. M. M. Eggermont et al.

Background

Aggressive fibromatoses (desmoid tumours) may be locally aggressive, but do not metastasize. Although a conservative approach is advocated for most patients, pain and functional impairment are indications for active treatment. Tumour necrosis factor (TNF) α and melphalan‐based isolated limb perfusion (TM‐ILP) is a limb‐saving treatment modality for soft tissue tumours. This study reports the results of TM‐ILP treatment in patients with aggressive fibromatosis.

Method

Institutional databases of three European centres were searched. All patients who received TM‐ILP treatment for aggressive fibromatosis between 1990 and 2012 were included. Before therapy, the patients were discussed at multidisciplinary tumour board meetings.

Results

Twenty‐five patients received 28 TM‐ILP treatments. The median age of patients was 28 (i.q.r. 19–34) years and median hospital stay was 8 (7–12) days. Median follow‐up was 84 (34–114) months. A complete response was achieved after two TM‐ILP treatments, and a partial response after 17 treatments in 16 patients. Stable disease was reported after eight treatments in seven patients, including a patient with stable disease after the first treatment and progression after the second TM‐ILP. Toxicity was modest after most treatments; Wieberdink grade IV (extensive epidermolysis, and threatening or manifest compartment syndrome) was seen after two TM‐ILP treatments. Systemic leakage was reported after one treatment, but did not lead to systemic toxicity. Functional outcome was good; 16 patients had no physical limitations, and six patients had some limitations but did not need medical aids. Amputation was prevented in all but three patients.

Conclusion

TNF‐α‐based ILP is effective in patients with aggressive fibromatosis.

Full text

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Isolated limb perfusion using tumour necrosis factor α and melphalan in patients with advanced aggressive fibromatosis. BJS 2014; 101: 1674-1680.

Background

Method

Results

Conclusion

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