Isolated Limb Infusion: A Single-Center Experience with Over 200 Infusions.

Abstract

Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy to an extremity for patients with locally advanced cutaneous malignancies and sarcoma. A single-institution, prospectively collected database was analyzed for intention-to-treat with ILI. From 2007 to 2016, 163 patients underwent 205 procedures (201 were successfully completed), and four malignancies were treated: melanoma (72.1% of all ILIs), sarcoma (23.4%), squamous cell carcinoma (SCC; 2.0%) and Merkel cell carcinoma (MCC; 2.5%). A median grade II regional Wieberdink toxicity score was observed, with 88.1%of patients experiencing grade II or less. Median follow-up was 21.8months, and overall response rate (ORR) was 59.0% for melanoma, 48.9% for sarcoma, 50.0% for SCC, and 60.0% for MCC. A significant difference (p=0.04) between upper (76.9%) and lower extremity (55.1%) ORR was observed in patients with melanoma. When comparing responders with nonresponders, patients with melanoma had significantly longer in-field progression-free survival (IPFS; 14.1 vs. 3.2months, p<0.001), distant metastatic-free survival (DMFS; not reached vs. 25.8months, p=0.006), and overall survival (OS; 56.0 vs. 26.7months, p=0.0004). Sarcoma responders had a significantly longer IPFS (13.0 vs. 2.7months, p<0.0001), but no significant distant metastatic or OS advantage. Over a median follow-up of 19.3months, sarcoma patients had an overall limb salvage rate of 68.4%. ILI is a well-tolerated procedure for patients with locally advanced melanoma, sarcoma, and other cutaneous malignancies. ILI responders had a significantly longer time to IPFS, while melanoma responders alsohad a DMFS and OS advantage.