PhD ceremony Ms. M.L. Hoven-Gondrie: Soft-tissue sarcomas of the extremities: aspects of survival and long-term results of isolated limb perfusion

PhD ceremony: Ms. M.L. Hoven-Gondrie, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Soft-tissue sarcomas of the extremities: aspects of survival and long-term results of isolated limb perfusion

Promotor(s): prof. H.J. Hoekstra, prof. A.J.H. Suurmeijer

Faculty: Medical Sciences

All patients ≥18 years, diagnosed with extremity soft-tissue sarcoma between 1989 and 2008, are analysed with data from the Netherlands Cancer Registry, in order to assess time trends in presentation, treatment and survival. Furthermore, research was performed to discover differences in presentation, treatment and survival of extremity soft-tissue sarcoma patients of different age groups and to assess the impact of age on relative survival of these patients in the Netherlands. As elderly patients are at risk for over- as well as under-treatment, are less often included in clinical trials, and less often referred to a specialized sarcoma care centre, we performed this study on soft-tissue sarcoma care in the elderly to gain better insight into treatment and survival differences.

For patients with primarily irresectable locally advanced extremity soft-tissue sarcomas an established treatment strategy is isolated limb perfusion (ILP) with TNFα and melphalan, followed by delayed surgical resection and, if indicated, external-beam radiotherapy. With a long-term limb-salvage rate of 78% and a local recurrence rate of 14%, ILP appears to be a safe and effective procedure, although long-term damage to the healthy surrounding tissues cannot be prevented. Sometimes major late vascular morbidity even requires amputation. After 20 years of experience with this combined modality treatment, we evaluated the safety and effectiveness of changes in the procedure of ILP, such as dose reduction of TNFα and shorter duration of ILP, morbidity of the procedure, and long-term patient outcomes.