Intraarterial mitoxantrone and paclitaxel in a patient with Stewart-Trevessyndrome: selection of chemotherapy by an ex vivo ATP-based chemosensitivity assay

We report on a 72-year-old patient developing Stewart-Treves syndrome (STS) of the right arm 9 years after curative irradiation for ipsilateral stage III breast cancer. Facing the poor track record of both irradiation and che motherapy in this highly malignant lymphangiosarcoma, amputation was recomm ended but refused by the patient. Therefore, limb conserving-therapy using three courses of intra-arterial mitoxantrone (MX) and paclitaxel (PTX) was attempted. This novel chemotherapy protocol was selected by pretherapeutic ex vivo ATP-based chemosensitivity testing of autologous tumor tissue. The patient experienced complete response, which was subsequent histologically confirmed by compartment resection. When developing recurrent STS outside o f the perfused area 6 months after primary therapy, the patient was reteste d and reinduced with three other courses of intra-arterial MX/PTX which aga in produced durable complete remission. This case demonstrates the benefit of individualized therapy in this prognostically desperate disease allowing both limb conservation and maintained quality of life. [(C) 2000 Lippincot t Williams & Wilkins.].