Isolated limb perfusion for locally advanced angiosarcoma in extremities: A multi-centre study. (November 2017)

• Record Type: Journal Article
• Authors: Huis in 't Veld, E.A.; Grünhagen, D.J.; Verhoef, C.; Smith, H.G.; van Akkooi, A.C.J.; Jones, R.; van Coevorden, F.; Hayes, A.J.; van Houdt, W.J.
• Is Part Of: European journal of cancer. Volume 85(2017)
• Page Start: 114
• Page End: 121
• Publication Date: 2017-11
• Subjects: Locally advanced angiosarcoma -- Angiosarcoma -- Isolated limb perfusion -- ILP -- Sarcoma -- Limb salvage technique -- Cutaneous angiosarcoma of the extremity; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2017.07.023
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Angiosarcomas are rare and aggressive soft-tissue sarcomas. The only potential curative treatment is complete surgical excision. This study reports the outcome of isolated limb perfusion (ILP) with high-dose melphalan and tumour necrosis factor α for locally advanced angiosarcoma. Material and methods: All patients who underwent an ILP for angiosarcomas between 1991 and 2016 in three tertiary referral centres were identified from prospectively maintained databases. Results: A total of 39 patients were included, with a median follow-up of 18 months (interquartile range 6.1–60.8). Of these patients, 23 (58.9%) patients had a complete response (CR) after ILP, 10 (25.6%) had a partial response, 4 (10.3%) had stable disease and 2 (5.1%) patients had progressive disease immediately after ILP. A total of 22 patients developed local progression (56.4%), whereas nine (23.1%) developed distant metastases. The patients with CR had a significantly prolonged median local progression-free survival (PFS) (15.4 versus 7.3 months, p = 0.015) when compared with non-CR patients, and a trend towards better median overall survival (81.2 versus 14.5 months, p = 0.054). Six patients underwent multiple ILPs, whereby the CR rate of the first, second and third ILPs were 60%, 80% and 67%, respectively. Thirteen (33.3%) patients needed further surgical intervention, consisting of resection in eight patients (20.5%) and amputation in five patients (12.8%). Conclusion: ILP is an effective treatment option for patients with locally advanced angiosarcoma in the extremities, resulting in a high number of CRs, a high limb salvage rate and prolonged local PFS. Highlights: Isolated limb perfusion (ILP) is a save option for the treatment of locally advanced angiosarcomas of the extremities. ILP for extremity angiosarcoma results in high complete response rates, with a prolonged local progression-free survival (PFS). With high limb salvage rates, ILP is a good option for locally advanced angiosarcomas. Even after recurrence, further treatment such as repeated ILPs or other treatment modalities can result in prolonged PFS.