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Isolated Limb Infusion in a Series of over 100 Infusions, a Single Center Experience #MMPMID23456376
Wong J; Chen YA; Fisher KJ; Zager JS
Ann Surg Oncol 2013[Apr]; 20 (4): 1121-7 PMID23456376show ga
Introduction: Isolated limb infusion (ILI) is a therapeutic option for patients with recurrent, unresectable extremity malignancies. Methods: A prospectively collected single institution database of patients undergoing ILI was analyzed for preoperative, intraoperative, and postoperative parameters and outcomes. Results: From 5/2007-1/2012, 76 patients successfully underwent initial ILI, and 28 following either previous hyperthermic isolated limb perfusion (HILP) or ILI. Seventy-nine (74%) patients had melanoma, 24 (22%) sarcoma, 3 (3%) Merkel cell and 1 (1%) squamous cell carcinoma. There were 55 (72%) initial and 22 (79%) repeat lower extremity (LE) ILI?s, and 21 (78%) initial and 6 (22%) repeat upper extremity (UE) ILI?s. Serologic toxicity, measured by serum creatine kinase (CK), peaked higher and later in LE ILI?s, median 620 vs. 124 IU/L and postoperative day 4 vs. 2, respectively, P<0.05. LE ILI?s had a longer hospital length of stay (LOS), median 6 vs. 5 days (P<0.0001). A median of grade II Wieberdink regional toxicity was observed. Three-month follow-up was available in 94 (90%). A response (ORR) was seen in 72% of ILI?s performed for melanoma and 58% for sarcoma. No difference in response was observed between UE vs. LE or between initial vs. repeat ILI?s. Repeat UE ILI?s, however, appeared to have an improved ORR than repeat LE ILI?s, 83% vs. 64%. Conclusion: ILI may be successfully performed for cutaneous and soft tissue malignancies. LE ILI?s have higher CK levels and slightly longer LOS. Repeat ILI?s are not associated with increased toxicity and similar ORR. UE ILI?s may have better overall response rates.