The World's First Extended Isolated Stopflow Limb Infusion (EISLI) to Treat Osteosarcoma Results in Complete Remission
A young woman faced the choice of fighting her cancer conventionally and losing her leg in the process or attempting to save her leg with a novel stop-flow infusion therapy. Not only did this new treatment save her leg, but she is still tumor-free 18 months later.
Osteosarcomas are rare, generally highly malignant, tumors that predominantly affect young people and develop in long, tubular shaft bones like the thigh. Because they typically grow quickly and metastasize early, attempts are generally made to shrink the tumor, with early combination chemotherapy followed by surgical excision, to save the affected limb where possible. However, if the tumor cannot be completely resected due to its location and spread, amputation is often unavoidable.
18-year-old patient diagnosed with highly aggressive osteosarcoma
To avert this outcome, an Extended Isolated Stopflow Limb Infusion (EISLI) was implemented for the first time to treat osteosarcoma at the Medias Hospital in Burghausen, which specializes in the application and further advancement of innovative therapies. The patient, in this case, is a young woman with a large tumor in her thigh, diagnosed as a highly aggressive osteosarcoma. Although the standard therapy of high-dose cytostatics had the desired effect on the tumor, it was discontinued early because of side effects that were not tolerated by the patient. Alternative treatment attempts proved ineffective, with clear progression of the disease including suspicious metastases in the groin and thigh region diagnosed after a few months. An external orthopedic department, therefore, recommended amputating the leg as a life-saving treatment option. But the patient decided against the amputation procedure, instead opting for a highly concentrated regional chemotherapy administered by Extended Isolated Stopflow Limb Infusion (EISLI).
To date, the first-ever innovative use of EISLI to treat osteosarcoma
The EISLI method developed at the Medias Hospital is a variant of limb perfusion adapted to the treatment of osteosarcoma. The principle of this therapy is to restrict chemotherapeutic treatment to the local area around the tumor by using a stop-flow infusion to isolate the tumor's blood supply from the patient's general circulation.
In the case presented here, this was achieved by positioning balloon catheters at arterial and venous branch points in the pelvis and appropriately directing the perfusion in this canceraffected region. This method allows the delivery of very high chemotherapy agent concentrations directly to the tumor site, which exceed the tumor concentrations normally achieved by conventional systemic chemotherapy many fold, whilst retaining a low total chemotherapy agent dose. Patients typically experience very few, if any, side effects with this procedure.
The tumor in the patient’s thigh was successfully shrunk after four EISLI treatment cycles, without any subjective side effects, and was subsequently completely resected by surgery. A knee joint endoprosthesis was then implanted and a final EISLI cycle administered. A PET-CT scan two months later found no evidence of local recurrence or distant metastases, and a follow-up examination at 18 months also failed to detect any traces of cancer.