Factors associated with response, survival, and limb salvage in patients undergoing isolated limb infusion.

TitleFactors associated with response, survival, and limb salvage in patients undergoing isolated limb infusion.
Publication TypeJournal Article
Year of Publication2014
AuthorsSteinman J, Ariyan C, Rafferty B, Brady MS
JournalJ Surg Oncol
Volume109
Issue5
Pagination405-9
Date Published2014 Apr
ISSN1096-9098
KeywordsAdult, Aged, Amputation, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Merkel Cell, Chemotherapy, Cancer, Regional Perfusion, Dactinomycin, Disease Progression, Drug Administration Schedule, Extremities, Female, Humans, Kaplan-Meier Estimate, Limb Salvage, Male, Melanoma, Melphalan, Middle Aged, Neoplasm Staging, Prospective Studies, Retrospective Studies, Sarcoma, Skin Neoplasms, Treatment Outcome, Tumor Burden
Abstract

BACKGROUND: Isolated limb infusion (ILI) is a percutaneous method of delivering regional chemotherapy to patients with recurrent tumors of the extremity. This study determines predictors of response, survival, and limb salvage.

METHODS: Single institution data from a prospective clinical trial and subsequent ILI experience were reviewed. Limb tumor burden was assessed in melanoma patients with "high" (≥10 lesions or one lesion >3 cm) or "low" burden (<10 lesions and no lesion >3 cm). Response was assessed at 3 months from ILI.

RESULTS: Between 1999 and 2011, 62 patients underwent ILI (58 melanoma, 2 Merkel cell carcinoma (MCC), 2 soft tissue sarcoma (STS)). Low tumor burden patients had more complete responses (CR) (11/23, 48%) than high tumor burden (3/32, 9%, P < 0.001); they had higher 5-year survival (69% vs. 29%, P = .007). Five-year survival rates based on response: 91% CR, 53% partial response (PR), 25% less than PR (P = 0.042, CR vs. PR). 7 patients (11%) underwent amputation due to disease progression; 3 had prior CR or PR.

CONCLUSIONS: Low tumor burden is a significant predictor of response in melanoma patients. Response to ILI is a significant predictor of survival. Progression of limb disease requiring amputation is not associated with any factors.

DOI10.1002/jso.23519
Alternate JournalJ Surg Oncol
PubMed ID24318953

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