Limb Preservation With Isolated Limb Infusion for Locally Advanced Nonmelanoma Cutaneous and Soft-Tissue Malignant Neoplasms | Clinical Pharmacy and Pharmacology | JAMA Surgery | JAMA Network
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Original Article
July 2011

Limb Preservation With Isolated Limb Infusion for Locally Advanced Nonmelanoma Cutaneous and Soft-Tissue Malignant Neoplasms

Author Affiliations

Author Affiliations: Division of Surgical Oncology, Medical College of Wisconsin Clinical Cancer Center, Milwaukee (Dr Turaga); Duke University, Durham, North Carolina (Drs Beasley and Tyler); Roswell Park Cancer Institute, Buffalo, New York (Dr Kane); Emory University, Atlanta, Georgia (Dr Delman); Department of Surgery, University of Florida, Gainesville (Dr Grobmyer); Departments of Cutaneous Oncology (Drs Gonzalez and Zager) and Sarcoma Oncology (Drs Gonzalez, Letson, Cheong, and Zager), Moffitt Cancer Center, Tampa, Florida; and Department of Surgery, University of South Florida, Tampa (Drs Gonzalez, Letson, Cheong, and Zager).

Arch Surg. 2011;146(7):870-875. doi:10.1001/archsurg.2011.139

Objective To demonstrate the efficacy of isolated limb infusion (ILI) in limb preservation for patients with locally advanced soft-tissue sarcomas and nonmelanoma cutaneous malignant neoplasms.

Background Locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms, including soft-tissue sarcomas of the extremities, can pose significant treatment challenges. We report our experience, including responses and limb preservation rates, using ILI in cutaneous and soft-tissue malignant neoplasms.

Methods We identified 22 patients with cutaneous and soft-tissue malignant neoplasms who underwent 26 ILIs with melphalan and dactinomycin from January 1, 2004, through December 31, 2009, from 5 institutions. Outcome measures included limb preservation and in-field response rates. Regional toxic effects were measured using the Wieberdink scale and serum creatinine phosphokinase levels.

Results The median age was 70 years (range, 19-92 years), and 12 patients (55%) were women. Fourteen patients (64%) had sarcomas, 7 (32%) had Merkel cell carcinoma, and 1 (5%) had squamous cell carcinoma. The median length of stay was 5.5 days (interquartile range, 4-8 days). Twenty-five of the 26 ILIs (96%) resulted in Wieberdink grade III or less toxicity, and 1 patient (4%) developed grade IV toxicity. The median serum creatinine phosphokinase level was 127 U/L for upper extremity ILIs and 93 U/L for lower extremity ILIs. Nineteen of 22 patients (86%) underwent successful limb preservation. The 3-month in-field response rate was 79% (21% complete and 58% partial), and the median follow-up was 8.6 months (range, 1-63 months). Five patients underwent resection of disease after an ILI, of whom 80% are disease free at a median of 8.6 months.

Conclusions Isolated limb infusion provides an attractive alternative therapy for regional disease control and limb preservation in patients with limb-threatening cutaneous and soft-tissue malignant neoplasms. Short-term response rates appear encouraging, yet durability of response is unknown.