Angiosarcomas are rare aggressive sarcomas that count for 2% of all soft tissue sarcomas. The only potential curative treatment is complete surgical excision, but a large subset of patients present with locally advanced disease. The aim of this study was to evaluate the effectiveness of Isolated Limb Perfusion (ILP) as an alternative treatment option for locally advanced angiosarcoma in the extremities.
All patients who underwent an ILP for angiosarcomas between October 1991 and October 2016 in three tertiary referral centres were identified from 3 prospectively maintained databases. Demographics, tumour, treatment and response characteristics and the disease course were all obtained from either the database or patient files. Statistical analysis was performed using SPSS statistics 24.
A total of 39 patients were included. The median age was 66 (range, 24-95) years. Of these patients, 23 (59%) patients had a complete resonse after ILP, 10 (25.6%) patients had a partial response, 4 (10.3%) had stable disease and 2 (5.1%) patients had local progression immediately after ILP. Of all patients, a total of 22 patients developed local progression (56,4%) while 10 (25.6%) developed distant metastases. Median time to progression; 7,4 months (IQR 3-14,9) and median time to distant metastasis of 6,4 months (IQR 1,5-44,9). The 10 (25,6%) patients with a complete response (compared to PR/SD/PD) had a non-significant trend towards better median overall survival (81,2 vs 14,5 months) (p = 0,054), and had a significantly prolonged median progression free survival (15,4 vs. 7,3 months) (p = 0,015). A total of 5 patients underwent multiple ILP’s whereby the complete response rate of the first, second and third ILP were 60% (n = 4/6), 80% (n = 4/5) and 67% (n = 2/3) respectively. Only 13 (33,3%) patients needed further surgical intervention, consisting of wide local excision in 8 patients (20,5%) and amputation in 5 patients (12,8%).
ILP should be considered as treatment option in the multidisciplinary management of patients with locally advanced limb angiosarcomas, resulting in a high limb salvage rate, high number of complete responses and prolonged progression-free survival.
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All authors have declared no conflicts of interest.