Hyperthermic isolated limb perfusion for extremity soft tissue sarcomas: Systematic review of clinical efficacy and quality assessment of reported trials

Background and Objectives Extremity soft tissue sarcomas (STS) are managed with radiotherapy and limb‐sparing surgery however aggressive or recurrent cases require amputation. Hyperthermic isolated limb perfusion (HILP) has been proposed as an alternative. Our aim was to systematically review phase...

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Bibliographic Details
Published in:	Journal of surgical oncology Vol. 106; no. 8; pp. 921 - 928
Main Authors:	Trabulsi, N.H., Patakfalvi, L., Nassif, M.O., Turcotte, R.E., Nichols, A., Meguerditchian, A.N.
Format:	Journal Article
Language:	English
Published:	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-12-2012 Wiley Subscription Services, Inc
Subjects:	advanced disease Chemotherapy, Cancer, Regional Perfusion Clinical Trials, Phase II as Topic Extremities Humans Hyperthermia, Induced limb Quality Assurance, Health Care Randomized Controlled Trials as Topic regional chemotherapy Sarcoma - drug therapy Treatment Outcome
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Summary:	Background and Objectives Extremity soft tissue sarcomas (STS) are managed with radiotherapy and limb‐sparing surgery however aggressive or recurrent cases require amputation. Hyperthermic isolated limb perfusion (HILP) has been proposed as an alternative. Our aim was to systematically review phase II HILP trials, assess tumor response, limb salvage (LS), and quality of scientific publications on this technique. Methods We conducted a literature search of electronic databases (MEDLINE, EMBASE, Scopus, Cochrane Library) and clinical trial registries for phase II HILP trials on non‐resectable extremity STS. Outcomes of interest were complete response (CR), partial response (PR), and LS rates. Quality of published trials was assessed using a quality checklist. Results Of 518 patients across 12 studies, 408 had some response (CR or PR), and 428 had the limb spared. Median CR, PR, and LS rates were 31%, 53.5%, and 82.5%, respectively. Median Wieberdink loco‐regional toxicity rates were 3.8%, 45.5%, 17%, 1%, and 0% for levels 1–5, respectively. No trial fulfilled either all ideal or essential quality criteria. Seven trials did not include statistical methodology. Conclusion HILP seems effective in treating advanced extremity STS. However, poor publication quality hinders results validity. Technical and methodological standardization, well‐designed, multi‐institutional trials are warranted. J. Surg. Oncol. 2012; 106: 921–928. © 2012 Wiley Periodicals, Inc.
Bibliography:	Cedars Cancer Institute (Montreal, Canada) ArticleID:JSO23200 istex:83DBC745830D612D33C2D0A677BC02F372D78F14 ark:/67375/WNG-WSTB4D0D-J
ISSN:	0022-4790 1096-9098
DOI:	10.1002/jso.23200