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Turaga KK, Beasley GM, Kane JM, et al. Limb Preservation With Isolated Limb Infusion for Locally Advanced Nonmelanoma Cutaneous and Soft-Tissue Malignant Neoplasms. Arch Surg. 2011;146(7):870–875. doi:10.1001/archsurg.2011.139
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).
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.
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