Isolated limb perfusion with high-dose tumor necrosis factor alpha and melphalan for Kaposi sarcoma

Background: Although the classic form of Kaposi sarcoma is considered indol ent 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 alpha and melphalan as a limb-sparing mod ality 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 candida tes for amputation owing to debilitating symptoms. Interventions: Patients underwent ILP through the iliac (n = 2), femoral (n = 2), and popliteal (n = 1) vessels. Tu mor necrosis factor alpha, 4 mg, a nd melphalan, 1.5 mg/kg body weight, were perfused for an overall time of 9 0 minutes. The limb was heated to 40 degrees C. Clinical and pathological r esponses were recorded for all patients after 6 to 8 weeks. Results: The overall response rate was 100%: 1 of 5 patients had complete r esponse and 4 of 5 had partial response. Two patients had progression of di sease 2 months after ILP but one of them was asymptomatic and did not requi re any further treatment. The second patient underwent amputation. Thus, li mb 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 necrosi s factor a and melphalan can be considered an effective palliative and limb -sparing treatment modality for extensive Kaposi sarcoma.