title: Factors associated with response, survival, and limb salvage in patients undergoing isolated limb infusion.
abstract: BACKGROUND
  Isolated limb infusion (ILI) is a percutaneous method of delivering regional chemotherapy to patients with recurrent tumors of the extremity. This study determines predictors of response, survival, and limb salvage.
  
  
  METHODS
  Single institution data from a prospective clinical trial and subsequent ILI experience were reviewed. Limb tumor burden was assessed in melanoma patients with "high" (≥10 lesions or one lesion >3 cm) or "low" burden (<10 lesions and no lesion >3 cm). Response was assessed at 3 months from ILI.
  
  
  RESULTS
  Between 1999 and 2011, 62 patients underwent ILI (58 melanoma, 2 Merkel cell carcinoma (MCC), 2 soft tissue sarcoma (STS)). Low tumor burden patients had more complete responses (CR) (11/23, 48%) than high tumor burden (3/32, 9%, P < 0.001); they had higher 5-year survival (69% vs. 29%, P = .007). Five-year survival rates based on response: 91% CR, 53% partial response (PR), 25% less than PR (P = 0.042, CR vs. PR). 7 patients (11%) underwent amputation due to disease progression; 3 had prior CR or PR.
  
  
  CONCLUSIONS
  Low tumor burden is a significant predictor of response in melanoma patients. Response to ILI is a significant predictor of survival. Progression of limb disease requiring amputation is not associated with any factors.
authors: Department of Surgery, Gastric, Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors: Jonathan
authors: J
authors: Steinman
authors: Charlotte
authors: C
authors: Ariyan
authors: Brian
authors: B
authors: Rafferty
authors: Mary S
authors: MS
authors: Brady
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D015266:Carcinoma, Merkel Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010478:Chemotherapy, Cancer, Regional Perfusion; D003609:Dactinomycin / Q000008:administration & dosage / Q000031:analogs & derivatives; D018450:Disease Progression; D004334:Drug Administration Schedule; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage / Q000706:statistics & numerical data; D008297:Male; D008545:Melanoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: C030013:cactinomycin; D003609:Dactinomycin; D008558:Melphalan
keywords: Merkel cell carcinoma; limb tumor burden; recurrent melanoma; soft tissue sarcoma