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La perfusion de extremidad aislada (PEA) con solo melfalan no ha mostrado eficacia en el tratamiento de sarcomas de partes blandas (SPB) irresecables de extremidad. Esta situacion se ha visto modificada con la aparicion del factor de necrosis tumoral-α (TNF), farmaco que ataca los vasos tumorales y aumenta de tres a seis veces la captacion selectiva de otros medicamentos por el tumor. Durante los ultimos diez anos, diversos estudios han demostrado que la combinacion de TNF y melfalan, administrada mediante PEA, produce un efecto antitumoral espectacular. En la actualidad es el tratamiento estandar para los pacientes con SPB de extremidad irresecables y subsidiarios de amputacion fisica o funcional del miembro afecto, ya que en mas del 70% de los casos logra una disminucion de la tumoracion suficiente como para realizar posteriormente una cirugia de exeresis del residuo tumoral con conservacion fisica y funcional de la extremidad.
Palabras clave:
perfusión de extremidad aislada
sarcomas de partes blandas irresecables
nuevo estándar
Isolated limb perfusion (ILP) with melphalan alone is not effective in the therapy of unresectable soft-tissue sarcomas (STS) of the extremities. Tumor necrosis factor-á (TNF), a drug that destroys tumor vessels and enhances tumor drug uptake three-fold to six-fold, has definitely changed this situation. In the last decade, investigations have shown that ILP with TNF and melphalan has impressive antitumoral effects. Nowadays, it is considered the standard treatment for unresectable limb STS, in which physical or functional amputation is advocated, since major tumor remission is achieved in more than 70% of cases, making surgical excision of the remnant tumor with physical and functional limb preservation possible.
Key words:
isolated limb perfusion
unresectable soft-tissue sarcomas
new standard
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