The use of isolated limb infusion in limb threatening extremity sarcomas

Abstract

Background Locally advanced, limb threatening soft tissue sarcomas (STS) pose a significant treatment challenge. We report our experience using isolated limb infusion (ILI) in patients with unresectable extremity STS. Methods Twenty-two patients with extremity STS underwent 26 ILIs with melphalan and dactinomycin. Patient characteristics, intra-operative parameters and toxicity were recorded. Outcome measures included limb-salvage and in-field response rates. Results Of the 19 lower and 7 upper extremity ILIs, Wieberdink grade III toxicity or less was observed in all. Median follow up was 11 months. Seventeen patients were evaluable at 3 months post ILI with an overall response rate of 42%. Four (24%) had complete response (CR), 3 (18%) partial response (PR), 3 (18%) stable disease (SD) and 7 (41%) progressive disease (PD). Twelve of 17 (71%) underwent successful limb preservation at a median of 9 months post ILI. Two (12%) were downstaged to resectable disease and remain NED after surgery at 30 and 22 months post ILI. Conclusions ILI is an attractive modality that provides regional disease control and limb preservation in patients with limb threatening sarcoma. Although short term results appear encouraging, long term follow up is needed to fully assess the role of ILI in unresectable extremity STS.

Regional therapy in metastatic melanoma: an update on minimally invasive intraarterial isolated limb infusion and percutaneous hepatic perfusion

“…any difference in the response rate [16]. In addition, in another study where patients underwent repeat ILI, those patients who had upper extremity ILI had better overall response rates than those with lower extremity ILI [17].…”

“…There was no statistical difference in survival or toxicity after the repeat procedures Vohra et al [16] 22 STS ILI Retrospective 42% overall response rate (24% CR, 18% PR, 18% SD, 41% PD), unknown duration of response Wong et al [17] 77 in humans. Because of these features, melphalan is considered the drug of choice for both HILP and ILI [8,23].…”

“…Response rates for nonmelanoma cutaneous malignancies and soft tissue sarcoma in small series of patients have ranged anywhere from 42 to 79% [16,22]. However, the duration of response is unknown, as the retrospective studies did not have data on long-term follow up [16,22].…”

Isolated limb infusion: Efficacy, toxicity and an evolution in the management of in-transit melanoma

“…Postoperative therapeutic anticoagulation was instituted after two patients developed DVTs. DVT rates of 4% to 14% following ILI have been described in other series (11,23,24). Postoperative steroids were used selectively on the basis of Wieberdink toxicity and/or elevated creatine kinase.…”

“…Chemotherapy doses were calculated from limb volumes measured using the water displacement technique or circumferential limb measurements (6,11,23,24 the affected limb by an interventional radiologist (6 Fr for the artery, 8 Fr with multiple side-holes for the vein). Lower limb catheters were inserted via the contralateral groin and advanced to a position proximal to the knee.…”