M6 - Isolated Limb Perfusion as an Effective Treatment Modality for Locally Advanced Kaposi Sarcoma of the Extremities

Introduction: Kaposi sarcoma (KS) is a rare soft tissue sarcoma. In case of locally advanced disease, mutilating surgery including amputation can sometimes be inevitable. The aim of this study was to evaluate the effectiveness of isolated limb perfusion (ILP) in patients with locally advanced KS of the extremities. Material and methods: All patients who underwent ILP for KS between 1996 and 2018 at Erasmus MC, Rotterdam were included. Clinical data was obtained from either a prospectively maintained database or patient files.

Results: A total of 19 ILP's - of which 14 primary ILP's and 5 recurrent ILP's- were performed in 14 extremities of 11 patients. Median follow-up from first ILP was 30 months (range, 5-98). The overall response rate of primary ILP was 100%, with a complete response (CR) rate of 50%. Only minimal local toxicity (i.e. Wieberdink I-III) was observed. Local progressive disease occurred after eight primary ILP's (57%) with a median local progression free survival (PFS) of 18 months (95% confidence interval [CI]: 7.0-28.9). Four (46%) patients received multiple ILP's on the same leg, with an overall response- and CR-rate after the second ILP of 75% and 50% respectively. One patient needed amputation post-operatively resulting in a limb salvage rate of 91%. One (9%) patient developed distant recurrence four months after ILP.

Conclusions: ILP is an effective treatment modality for patients with locally advanced KS of the extremity. Due to the high CR rate and low toxicity, ILP could be considered for locally advanced KS of the extremities.