title: Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms.
abstract: 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.
authors.affiliation: Division of Surgical Oncology, Medical College of Wisconsin Clinical Cancer Center, Milwaukee, USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Georgia M
authors.initials: GM
authors.lastname: Beasley
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Keith A
authors.initials: KA
authors.lastname: Delman
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.forename: G Douglas
authors.initials: GD
authors.lastname: Letson
authors.forename: David
authors.initials: D
authors.lastname: Cheong
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D014408:Biomarkers, Tumor / Q000097:blood; D015266:Carcinoma, Merkel Cell / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods; D003402:Creatine Kinase / Q000097:blood; D003609:Dactinomycin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D012983:Soft Tissue Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D014408:Biomarkers, Tumor; D003609:Dactinomycin; D003402:Creatine Kinase; D008558:Melphalan