title: Isolated limb infusion: Efficacy, toxicity and an evolution in the management of in-transit melanoma.
abstract: BACKGROUND
  Isolated limb infusion (ILI) delivers low-flow chemotherapy via percutaneous catheters to treat melanoma in-transit metastases.
  
  
  OBJECTIVE
  To describe the experience of two regional referral centres with ILI.
  
  
  METHODS
  A retrospective review of patients who underwent ILI between 2002 and 2012 was performed. Outcomes were measured using the WHO criteria for response, the Wieberdink toxicity score and long-term limb function using the Toronto Extremity Salvage Score (TESS).
  
  
  RESULTS
  Fifty-two patients (mean age 66 years [range 27 to 90 years], female sex 65%, and lower [treated] limb in 86%) with 54 ILIs were reviewed. Wieberdink toxicity score was ≥3 in 21 (39%) procedures. Median follow-up was 18 months (range one to 117 months). Initial complete response (CR) was 29%, partial response 27%, stable disease 18% and progressive disease 27%. Predictors of better initial response were low disease burden and previous treatment. One or more treatments after ILI were common (65%). At 12 months, 19% of ILI patients had died from melanoma but 44% of surviving patients experienced limb CR. At 24 months, 57% of surviving patients experienced limb CR. The quality of life in the surviving, contactable patients according to the Toronto Extremity Salvage Score was 89%.
  
  
  CONCLUSIONS
  Even if ILI does not result in CR for melanoma intransit metastases. it may slow disease progression as a single therapy, but more frequently in combination with other modalities.
authors.affiliation: Division of Surgical Oncology;
authors.forename: Laura
authors.initials: L
authors.lastname: Chin-Lenn
authors.affiliation: Division of Surgical Oncology; ; Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta.
authors.forename: Claire
authors.initials: C
authors.lastname: Temple-Oberle
authors.affiliation: Division of Surgical Oncology;
authors.forename: J Gregory
authors.initials: JG
authors.lastname: McKinnon
keywords: In-transit metastasis; Isolated limb infusion; Melanoma
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