title: Technique and outcomes of isolated limb infusion for locally advanced malignant melanoma--a radiological perspective.
abstract: OBJECTIVE
  Isolated limb infusion (ILI) is a novel, minimally invasive technique for delivering high-dose regional chemotherapy in patients with recurrent and in-transit melanoma. The aim of this study was to review our single-centre experience in treating eleven patients. We emphasize the role of radiologists in setting up this service, including pre-treatment workup and placement of vascular catheters.
  
  
  METHODS
  A retrospective analysis of 11 patients who underwent 12 procedures between 2005 and 2009 was performed. Pre-procedural staging computed tomography (CT), CT angiography, and duplex studies were performed. All patients received a cytotoxic combination of melphalan and actinomycin-D via radiologically placed arterial and venous catheters in the affected limb under mild hyperthermic conditions. The outcome measures include response rates, limb toxicity, complications, and survival.
  
  
  RESULTS
  All patients were female with a mean age of 72 years. Three patients had American Joint Committee on Cancer (AJCC) stage IIIB melanoma, seven had stage IIIC melanoma, and one had a stage IIIB Merkel cell tumour. Complete response was seen in five patients (46%), partial response in four (36%), and progressive disease in two (18%). One patient developed grade 4 toxicity requiring a fasciotomy and another experienced systemic toxicity.
  
  
  CONCLUSIONS
  These outcomes are comparable to previous studies and shows that ILI is effective in locoregional control of unresectable melanoma. It is a relatively safe procedure but not without risk. Our experience shows the importance of radiological input to ensure safe and effective delivery of services.
authors.affiliation: Department of Radiology, St George's Hospital, London, UK. drjyc78@gmail.com
authors.forename: J-Y
authors.initials: JY
authors.lastname: Chun
authors.forename: M
authors.initials: M
authors.lastname: Hussain
authors.forename: B
authors.initials: B
authors.lastname: Powell
authors.forename: A-M
authors.initials: AM
authors.lastname: Belli
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003609:Dactinomycin / Q000008:administration & dosage*; D005121:Extremities; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008545:Melanoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage*; D009367:Neoplasm Staging; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D003609:Dactinomycin; D008558:Melphalan