title: The use of isolated limb infusion in limb threatening extremity sarcomas.
abstract: This paper reports a single-institution experience with the use of isolated limb infusion for limb salvage in locally advanced, unresectable, recurrent limb threatening soft tissue sarcomas.
  
  
  BACKGROUND
  Locally advanced, limb threatening soft tissue sarcomas (STS) pose a significant treatment challenge. We report our experience using isolated limb infusion (ILI) in patients with unresectable extremity STS.
  
  
  METHODS
  A total of 22 patients with extremity STS underwent 26 ILIs with melphalan and dactinomycin. Patient characteristics, intra-operative parameters and toxicity were recorded. Outcome measures included limb-salvage and in-field response rates.
  
  
  RESULTS
  Of the 19 lower and 7 upper extremity ILIs, Wieberdink grade III toxicity or less was observed in all. Median followup was 11 months. A total of 17 patients were evaluable at 3 months post-ILI with an overall response rate of 42%. Four (24%) had complete response (CR), three (18%) partial response (PR), three (18%) stable disease (SD) and seven (41%) progressive disease (PD). Twelve of 17 (71%) underwent successful limb preservation at a median of 9 months post-ILI. Two (12%) were downstaged to resectable disease and remain showing no evidence of disease (NED) after surgery at 30 and 22 months post-ILI.
  
  
  CONCLUSIONS
  ILI is an attractive modality that provides regional disease control and limb preservation in patients with limb threatening sarcoma. Although short-term results appear encouraging, long-term follow-up is needed to fully assess the role of ILI in unresectable extremity STS.
authors.affiliation: Department of Sarcoma Oncology, Moffitt Cancer Center, Tampa, Florida 33612, USA.
authors.forename: Nasreen A
authors.initials: NA
authors.lastname: Vohra
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.forename: Anthony
authors.initials: A
authors.lastname: Conley
authors.forename: Damon
authors.initials: D
authors.lastname: Reed
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Bui
authors.forename: David
authors.initials: D
authors.lastname: Cheong
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Letson
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; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D012509:Sarcoma / Q000188:drug therapy*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D003609:Dactinomycin; D008558:Melphalan