Large unresectable STS presents a therapeutic challenge. Several options are being explored to avoid amputation without compromising the oncological outcome. Neoadjuvant chemotherapy delivers inconsistent and rather unsatisfactory results, preoperative radiotherapy compromises healing, hence it can impede adjuvant systemic treatment. We present a case report of neoadjuvant use of isolated limb perfusion with TNF-alfa and Alkeran (Melphalan) in a patient with initially unresectable large myxoid liposarcoma of the thigh. We achieved 55% reduction in size of the tumor that allowed for wide resection with a safe margin. Pathology confirmed 99% tumor necrosis. The patient has a full function of his extremity and is disease-free at one year follow-up. ILP should be considered as a treatment option which, in selected cases, can contribute to limb sparing surgery. Key words: sarcoma, soft tissue, regional perfusion, chemotherapy, surgery, orthopedic, limb salvage.

2 chirurgická klinika kardiovaskulární chirurgie 1 lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice Praha

Klinika onkologie 1 lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice Praha

Ortopedická klinika 1 lékařské fakulty Univerzity Karlovy Fakultní nemocnice Na Bulovce a Institutu postgraduálního vzdělávání ve zdravotnictví Praha

Ústav patologie 1 lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Na Bulovce Praha

Isolated Limb Perfusion Can Avert Amputation Indication in Initially Nonsalvageable Sarcomas of the Extremities