Scripties UMCG - Rijksuniversiteit Groningen
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Isolated limb perfusion in patients with locally extensive Kaposi sarcoma of the extremities; an effective treatment modality

(2019) Boere, Th. (Thomas)

Background: Kaposi sarcoma (KS) is a rare soft tissue sarcoma. In case of severe locally extensive disease, amputation or mutilating surgery can sometimes be inevitable. The aim of this study was to evaluate the effectiveness of isolated limb perfusion (ILP) with melphalan and tumour necrosis factor α (TNF) in patients with locally advanced KS in the extremities.
Material and methods: A retrospective cohort study was performed with patients who underwent ILP for KS between 1996 and 2018 at Erasmus MC, Rotterdam. The required clinical data were obtained from either a prospectively maintained database or patient files. Survival analysis were performed with the Kaplan Meier method and the results were compared with the log rank test. Differences in groups were assessed by the fisher exact test or T-test. A p-value 0.05 was considered significant.
Results: A total of 19 ILP’s were performed in eleven patients. Median follow-up was 30 months (range, 5-98). The overall response rate to ILP was 95%, with a complete response (CR) rate of 53%, a partial response (PR) rate of 42% and stable disease (SD) was reported once (5%). Only minimal local toxicity, Wieberdink I-III, was observed. Local progression occurred after ten ILP’s (56%) with median time to progression of 10 months (range, 5-98). One (9%) patient developed systemic disease four months after ILP. One patient needed amputation post-operatively resulting in a limb salvage rate of 91%. Five (46%) patients received multiple ILP’s, the CR rate after the second and third ILP in this particular group was respectively 40% and 100%.
Conclusions: ILP with melphalan and TNF-α is an effective treatment modality for patients with locally advanced KS on the extremity. Due to the high CR rate and low toxicity, ILP should be considered in the multidisciplinary approach for KS.

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