Quality of life outcomes after isolated limb infusion.
BACKGROUND
Isolated limb infusion (ILI) for the treatment of in-transit melanoma was originally described more than 10 years ago. Response rates of 45-53% have been reported in U.S. series. Long-term quality of life outcomes after this procedure have not been described. We hypothesized that ILI is rarely associated with long-term limb morbidity.


METHODS
ILIs performed at our institution between July 2005 and June 2009 were reviewed. Patients were contacted cross-sectionally at 2 time points. During these interviews, response to treatment and postoperative limb function were assessed.


RESULTS
Thirty-two ILIs were performed during the time period. Twenty-seven patients were treated for in-transit melanoma; 5 were treated for recurrent Merkel cell carcinoma. The 30-day mortality was 0%. Three patients (9%) required fasciotomy. Durable complete responses were achieved in 41% of patients, with mean follow-up time of 19.4 ± 9.6 months after infusion; after this period, 53% reported progression of disease. The most common postprocedure symptoms were edema (88%), numbness (59%), and pain (59%). By 3 months and at the time of last follow-up, the most common symptoms were edema (82%), numbness (65%), and stiffness (35%). No patients reported impaired limb function at the time of last follow-up compared to baseline. Median survival was 19.2 ± 4.2 months after infusion.


CONCLUSIONS
ILI for melanoma and Merkel cell carcinoma is associated with postprocedure symptoms in most patients, most commonly edema, color change, and numbness. At last follow-up, no ILI patients had residual functional impairment in the treated limb.
Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Rebecca J
RJ
McClaine
Joseph S
JS
Giglia
Syed A
SA
Ahmad
Stephanie J
SJ
McCoy
Jeffrey J
JJ
Sussman
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001132:Arm; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy / Q000523:psychology; D003430:Cross-Sectional Studies; D003609:Dactinomycin / Q000008:administration & dosage; D004487:Edema / Q000209:etiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000209:etiology / Q000523:psychology; D007262:Infusions, Intravenous; D007866:Leg; D007902:Length of Stay; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000523:psychology*; D008558:Melphalan / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D011788:Quality of Life; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000523:psychology*; D015996:Survival Rate
D003609:Dactinomycin; D008558:Melphalan