
"The treatment options available for extremity sarcomas are amputation or limb-sparing surgery. Hypothermic isolated limb perfusion (HILP) in association with other treatments like radiation and chemotherapy may be an attractive option in extremity sarcomas for unresectable lesions to preserve limb function and maintain quality of life.  [12, 67, 74, 150]   Complete remission has occurred in at least one extremity LMS  following preoperative regional hyperthermia and chemotherapy [intra-arterial doxorubicin]. [107]  "Complications [of hyperthermic isolated limb perfusion] included chronic lymphedema, neuropathic pain, and prolonged wound healing." [12]  

In another study radio-hyperthermo-chemotherapy (RHC) was given to 44 patients with high-grade soft-tissue sarcomas of the limbs.  ... "Tumor shrinkage was observed in 98% (43/44) of the patients. Of the 36 patients with M0 tumors, 30 were disease-free at final follow-up, 2 had no evidence of disease, 1 was alive with disease, and 3 had died of the disease. Amputation was required only in the first patient, and the affected limb was preserved in the other 43 patients. The surgical margin was wide in 9 patients and marginal in 29 patients and intralesional excision was performed in 5 patients. There was recurrence in only 1 of the 44 patients. CONCLUSION: RHC is currently the most potent and relatively safe treatment method for high-grade soft-tissue sarcomas that is available clinically." [3]
In a study using hyperthermia with doxorubicin to treat STS limb lesions,  "the local recurrence rate was influenced by tumor site, type of trial, maximum tumor temperature, and local toxicity, whereas the overall survival was influenced by the presence of metastasis, tumor grade, and response to treatment." [26]

HOWEVER, in yet another study long-term results of hyperthermic isolated limb perfusion [ILP] showed a considerable local recurrence rate and a low disease-free survival. Perfusion in patients without tumor-free resection margins does not prevent local recurrence. We conclude that ILP with cisplatin, melphalan and Adriamycin should be considered carefully and is not an additional treatment strategy of first choice. [65]
