Isolated limb perfusion with rhTNF-alpha and melphalan for locally recurrent childhood synovial sarcoma of the limb.

The use of isolated, hyperthermic limb perfusion (ILP) for locally recurrent synovial sarcoma in two children is reported. In both cases recurrence was biopsy-proven after multiple surgical excisions followed by adjuvant chemo- and radiotherapy while no systemic metastases could be detected. ILP was performed using high-dose recombinant tumor necrosis factor alpha (rhTNF alpha) combined with melphalan via an extracorporeal circulation. Six weeks later, the former tumor bed and irradiation field was excised together with myocutaneous flap reconstruction for soft tissue coverage. The resection specimen revealed extensive necrosis of the tumor in both cases. Six months after completion of treatment, near-perfect limb function was determined by general clinical assessment and validated scoring systems. ILP, an accepted technique in treating adult extremity sarcoma, might also be of value in children as a means of limb-saving therapy.