 |
|
Isolated Limb Perfusion With High-Dose Tumor Necrosis Factor  and Melphalan for Kaposi Sarcoma
Dina Lev-Chelouche, MD;
Subhi Abu-Abeid, MD;
Ofer Merimsky, MD;
Josephine Isakov, MD;
Yoram Kollander, MD;
Isaac Meller, MD;
Joseph M. Klausner, MD;
Mordechai Gutman, MD
Arch Surg. 1999;134:177-180.
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  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 , 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 and melphalan can be considered an effective palliative and limb-sparing treatment modality for extensive Kaposi sarcoma.
From the Departments of Surgery (Drs Lev-Chelouche, Abu-Abeid, Klausner, and Gutman), Oncology (Dr Merimsky), and Orthopedic Oncology (Drs Isakov, Kollander, and Meller), Tel Aviv Sourasky Medical Centre, Tel Aviv University, Tel Aviv, Israel.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Kaposi's Sarcoma
Antman and Chang
NEJM 2000;342:1027-1038.
FULL TEXT
|
