Revolutionizing the treatment of locally advanced extremity soft tissue sarcomas: a review on TNFα-based isolated limb perfusion

Summary BACKGROUND: The treatment of locally advanced extremity soft tissue sarcoma poses a surgical challenge and may necessitate the amputation of the tumor-bearing extremity. Isolated limb perfusion with TNFα and melphalan was introduced as a neoadjuvant modality to facilitate limp-sparing surgery without influencing prognosis negatively. METHODS: Literature research of the PubMed database using Entrez, combined with the authors' experience. RESULTS: A limb salvage rate of approximately 80% and a local recurrence rate of 10–20% after delayed surgical resection have been reported and confirmed by multiple studies, with a low regional and systemic toxicity. CONCLUSIONS: TNFα-based isolated limb perfusion has revolutionized the treatment of locally advanced extremity soft tissue sarcomas. Further improvements are awaited after the introduction of new agents and novel approaches.