title: Isolated limb infusion with hyperthermia and chemotherapy for advanced limb malignancy: factors influencing toxicity.
abstract: BACKGROUND
  The isolated limb infusion (ILI) technique is a simpler and less invasive alternative to isolated limb perfusion, which allows regional administration of high-dose chemotherapy to patients with advanced melanoma and other malignancies restricted to a limb.
  
  
  METHODS
  Patients from two institutions, treated by ILI between 1998 and 2009 for extensive disease restricted to a limb, were included. The cohort included 31 patients with melanoma who presented with in-transit metastases or an extensive primary lesion, one patient with squamous cell carcinoma and another with epithelioid sarcoma not suitable for local surgical treatment.
  
  
  RESULTS
  A complete response was achieved in 26.3% of patients and a partial response in 52.6%. Toxicity was assessed according to the Wieberdink limb toxicity scale. Grade II toxicity was noted in 39.5% of patients, grade III in 50% and grade IV in 10.5%. Toxicity was correlated with the results of a number of clinical and laboratory tests. The toxicity of melphalan and actinomycin D was dose-dependent. For melphalan, the relationship between toxicity and mean dose was as follows: grade II--34.7 mg; grades III and IV--47.5 mg (P = 0.012). The relationship between toxicity and maximum serum creatine phosphokinase (CPK) was as follows: grade II--431.5 U/L; grades III and IV--3228 U/L (P = 0.010).
  
  
  CONCLUSIONS
  Toxicity after ILI is dose-dependent and serum CPK correlates with toxicity.
authors.affiliation: Department of Skin Oncology, Hospital do Câncer A.C. Camargo, São Paulo, Brazil.
authors.forename: João Pedreira
authors.initials: JP
authors.lastname: Duprat Neto
authors.forename: Ana Carolina C
authors.initials: AC
authors.lastname: Mauro
authors.forename: Andre S
authors.initials: AS
authors.lastname: Molina
authors.forename: Kenji
authors.initials: K
authors.lastname: Nishinari
authors.forename: Charles E
authors.initials: CE
authors.lastname: Zurstrassen
authors.forename: Odon F
authors.initials: OF
authors.lastname: Costa
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Belfort
authors.forename: Luciana
authors.initials: L
authors.lastname: Facure
authors.forename: José H
authors.initials: JH
authors.lastname: Fregnani
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000379:methods; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005121:Extremities; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008545:Melanoma / Q000628:therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012878:Skin Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D003609:Dactinomycin; D008558:Melphalan