Lassau N et al. (2005) Doppler US with perfusion software and contrast medium injection in the early evaluation of isolated limb perfusion of limb sarcomas: prospective study of 49 cases. Ann Oncol 16: 1054–1060

Isolated limb perfusion (ILP) is a safe and effective method for administering high doses of antineoplastic agents to a surgically isolated limb, allowing conservative excision of the residual tumor and avoiding the need for amputation. Lassau and colleagues at the Institute Gustave Roussy, France, have recently undertaken a prospective study of DOPPLER ULTRASONOGRAPHY WITH PERFUSION SOFTWARE AND CONTRAST AGENT INJECTION (DUPC) as an alternative to MRI for evaluating the efficacy of ILP in patients with locally advanced soft tissue sarcoma. The authors advocate the proposal of a new treatment-planning system based on the results of this study.

Patients enrolled in a large, randomized trial of tumor-necrosis factor-α therapy for soft tissue sarcoma were recruited to undergo DUPC the day before ILP and on days 1, 7, 15, 30, and 60 post-ILP. A decrease in contrast agent uptake of greater than 50% (DUPC) or tumor necrosis of >90% (MRI and histologic analysis) were indicative of a good response. A good response was observed in 25 out of 49 evaluable patients, as determined by MRI, histologic assessment and tumor necrosis. This response was predicted by DUPC at day 1 after ILP in 82% of all patients. At day 15 after ILP, the positive predictive value of DUPC was 100%. The authors conclude that the results of DUPC are comparable to MRI, but provide an earlier indication of response to ILP.