Common peroneal nerve palsy following TNF-based isolated limb perfusion for irresectable extremity desmoid tumor

Abstract

Hyperthermic isolated limb perfusion (ILP) (2 mg, TNF-alpha and 100mg, melphalan) was performed for an irresectable right thigh desmoid tumor with calf extension in a 49-year-old man. The patient had a history of four resections since the age of 19 years. Local ILP toxicity appeared with extensive edema and common peroneal neurologic impairment including paresis that remained severe 10 months later. One of the most troublesome side effects of perfusion is peripheral nerve damage, which has been reported at a rate of between 1 and 48% of perfused patients. ILP is an effective treatment in recurrence situations or where resection threatens loss of function; it, however, requires administration in specialized centers, progress in standardization and close monitoring to avoid locoregional toxicity, the mechanisms of which merit further investigation. Emergency compartmental pressure measurement may indicate fasciotomy, can be of great interest.

ILP-2: A New Bane and Therapeutic Target for Human Cancers

“…Studies have shown that ILP-2 cannot inhibit apoptosis induced by Fas or TNF, but can effectively inhibit apoptosis induced by Bax (Bcl-2 associated X protein) pathway ( 43 ). In tumor cells, ILP-2 can inhibit apoptosis by regulating the endogenous pathway of apoptosis mediated by Bcl-2/Bax.…”

Musculoskeletal desmoid tumours: Pre‐ and post‐treatment radiological appearances

“…Apart from the aforementioned forms of treatment for desmoid tumours, there is a wide array of other methods of treatment currently being investigated that have shown promising results. These include tyrosine kinase inhibitors such as imatinib or sorafenib, hormonal therapy such as tamoxifen, radio‐frequency ablation, percutaneous chemical ablation such as acetic acid and isolated limb perfusion for desmoid tumours in the extremities that are considered irresectable …”