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Tumor vascularization and histopathologic regression of soft tissue sarcomas treated with isolated limb perfusion with TNF‐α and melphalan
Author(s) -
Grabellus Florian,
Kraft Corinna,
SheuGrabellus SienYi,
Bauer Sebastian,
Podleska Lars E.,
Lauenstein Thomas C.,
Pöttgen Christoph,
Konik Margarethe J.,
Schmid Kurt W.,
Taeger Georg
Publication year - 2011
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21724
Subject(s) - medicine , histopathology , sarcoma , pathology , fibrosis , leiomyosarcoma , soft tissue sarcoma , regression , pathological , proportional hazards model , synovial sarcoma , soft tissue , psychology , psychoanalysis
Background Isolated limb perfusion (TM‐ILP) achieves high response rates in soft tissue sarcomas (STS). Some tumors show an insufficient association between radiological and pathological response. We investigated STS after TM‐ILP with a primary emphasis on histologic regression patterns. Methods In 53 patients with STS, TM‐ILP with subsequent tumor resection was performed. Regression was assessed by the Salzer‐Kuntschik regression scale. Microvessel density (MVD) of primary biopsies of 37 patients was determined by immunohistochemistry. Tumor regression was correlated with MVD of primary biopsies and other clinico‐pathological parameters. Results Regression presented mainly as necrosis or fibrosis/sclerosis upon histopathology. MFH, leiomyosarcoma, or clear cell sarcoma (CCS) responded well; whereas liposarcomas, synovial sarcomas, or MPNST were poor responders. MFH often had abundant necrosis; while other STS mainly presented with fibrosis/sclerosis. MVD had no influence on regression grade but modulated histologic regression patterns. Excellent regression demonstrated a trend toward an association with improved survival and local control. Conclusion TM‐ILP yielded high response rates in STS. Regression after TM‐ILP exhibits MVD‐dependent histopathologic patterns and variable efficacy in different sarcoma types. Complete regression seems to be a favorable prognostic factor. A concerted consideration of histopathology and clinical findings may contribute to a better clinical assessment of regression after TM‐ILP. J. Surg. Oncol. 2011; 103:371–379. © 2011 Wiley‐Liss, Inc.