Induction chemotherapy by isolated limb perfusion (ILP) followed by a wide resection may provide an alternative treatment to standard therapy in the management of locally advanced extremity soft tissue sarcomas (ESTS), according to a new study published Clinical Sarcoma Research.  Researchers reported that consideration should be given to induction ILP in young patients with large, high grade extremity sarcomas. They theorize these patients may benefit most from avoiding radiotherapy postoperatively.1

Jens Jakob, University Medical Center Göttingen, Germany, and colleagues compared the outcomes of patients undergoing induction ILP prior to limb-conserving surgery and selective postoperative radiotherapy with patients undergoing limb conserving surgery and routine postoperative radiotherapy. The 2 groups were matched for grade, size, and surgical resectability.

All the patients had primary, grade 2/3 sarcomas of the lower limbs of more than 10 cm. In this study, 80 patients received routine care and 44 received induction ILP.  The median size of the tumor was 13 cm across both groups, however, there were differences in the median age between both cohorts (median age was 60.5 years for standard group vs 56 years for the ILP group).

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The researchers found no significant differences between patients across the 2 groups when they examined 5-year local-recurrence rates (ILP 12.2% vs standard 20.1%) and distant metastases-free survival rates (ILP 49.6% vs standard 46.0%).  However, the study showed that fewer patients received postoperative radiotherapy in the ILP group compared with the standard group (27% versus 82%).


  1. Jakob J, Smith HG, Wilkinson MJ, et al. Regional chemotherapy by isolated limb perfusion prior to surgery compared with surgery and post‑operative radiotherapy for primary, locally advanced extremity sarcoma: a comparison of matched cohorts. Clin Sarcoma Res. 2018;8:12.