RT Journal
A1 Lev-Chelouche D, Abu-Abeid S, Merimsky O, et al
T1 ISolated limb perfusion with high-dose tumor necrosis factor α and melphalan for kaposi sarcoma
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD February 1
VO 134
IS 2
SP 177
OP 180
DO 10.1001/archsurg.134.2.177
UL http://dx.doi.org/10.1001/archsurg.134.2.177
AB Background 
    Although the classic form of Kaposi sarcoma is considered indolent and benign, at times its evolution is more severe, with an acute onset and debilitating complications necessitating aggressive treatment and even amputation.Objective 
    To evaluate the efficacy of hyperthermic isolated limb perfusion (ILP) with tumor necrosis factor α and melphalan as a limb-sparing modality for extensive regional Kaposi sarcoma.Setting 
    University hospital and national referral center.Patients 
    Five patients, aged 60 to 82 years, with extensive, symptomatic, classic Kaposi sarcoma of the lower limb were operated on. All were candidates for amputation owing to debilitating symptoms.Interventions 
    Patients underwent ILP through the iliac (n=2), femoral (n=2), and popliteal (n=1) vessels. Tumor necrosis factor α, 4 mg, and melphalan, 1.5 mg/kg body weight, were perfused for an overall time of 90 minutes. The limb was heated to 40°C. Clinical and pathological responses were recorded for all patients after 6 to 8 weeks.Results 
    The overall response rate was 100%: 1 of 5 patients had complete response and 4 of 5 had partial response. Two patients had progression of disease 2 months after ILP but one of them was asymptomatic and did not require any further treatment. The second patient underwent amputation. Thus, limb preservation was achieved in 80% (4 of 5 patients). Median follow-up was 24 months. There were no deaths associated with treatment or major system complications. Local complications were all reversible.Conclusion 
    These findings suggest that hyperthermic ILP with tumor necrosis factor α and melphalan can be considered an effective palliative and limb-sparing treatment modality for extensive Kaposi sarcoma.