Isolated Limb Infusion in a Series of Over 100 Infusions: A Single-Center Experience

Abstract

Isolated limb infusion (ILI) is a therapeutic option for patients with recurrent, unresectable extremity malignancies. A prospectively collected single-institution database of patients undergoing ILI was analyzed for preoperative, intraoperative, and postoperative parameters and outcomes. From May 2007 to January 2012, a total of 76 patients successfully underwent initial ILI, and 28 after either previous hyperthermic isolated limb perfusion or ILI. Seventy-nine patients (74%) 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) ILIs, and 21 (78%) initial and 6 (22%) repeat upper extremity (UE) ILIs. Serologic toxicity, measured by serum creatine kinase (CK), peaked higher and later in LE ILIs, median 620 versus 124IU/L, and postoperative day 4 versus 2, respectively (P<0.05). LE ILIs had a longer hospital length of stay (LOS), median 6 versus 5days (P<0.0001). A median grade II Wieberdink regional toxicity was observed. Three-month follow-up was available in 94 (90%). A response (overall response rate, ORR) was seen in 72% of ILIs performed for melanoma and 58% for sarcoma. No difference in response was observed between UE versus LE or between initial versus repeat ILIs. Repeat UE ILIs, however, appeared to have an improved ORR than repeat LE ILIs, 83 versus 64%. ILI may be successfully performed for cutaneous and soft tissue malignancies. LE ILIs have higher CK levels and slightly longer LOS. Repeat ILIs are not associated with increased toxicity and similar ORR. UE ILIs may have better ORR.