title: Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma.
abstract: BACKGROUND
  Treatment-resistant, locally advanced soft tissue sarcomas often require amputation for complete tumor extirpation. Isolated limb infusion (ILI) selectively delivers high-dose chemotherapy to the extremity in an attempt to achieve limb salvage. The aim of this study was to report perioperative and oncologic outcomes after ILI in patients with extremity soft tissue sarcomas.
  
  
  METHODS
  From 1994 to 2016, 77 patients underwent 84 ILIs at a total of 5 institutions. Melphalan and actinomycin D were circulated for 30 minutes after complete tourniquet occlusion of the limb, then actively washed out to prevent systemic exposure.
  
  
  RESULTS
  The procedure was performed in an upper extremity on 19 patients (21 infusions) and in a lower extremity on 58 patients (63 infusions). The 3-month overall response rate (ORR) for the entire cohort was 58%, and there was a statistically significant difference (p = 0.03) between upper (37%) and lower extremity (66%) ORR. With median follow-up of 20.6 months (range 0.6 to 146.1 months), the overall limb salvage rate was 77.9%. For those who underwent amputation due to progression of disease, the median time to amputation was 4.5 months. With a median follow-up of 20.6 months, the median overall survival for the entire cohort was 44.3 months. The distant metastatic-free survival was longer for responders than nonresponders (p = 0.01), though the disease-specific survival was not different for the same groups (p = 0.2).
  
  
  CONCLUSIONS
  Isolated limb infusion for extremity soft tissue sarcoma results in an objective response for half of the patients who are otherwise facing amputation, and offers prolonged limb salvage for the vast majority of patients. The procedure is well tolerated without serious complications.
authors.affiliation: Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL. Electronic address: john.mullinax@moffitt.org.
authors.forename: John E
authors.initials: JE
authors.lastname: Mullinax
authors.affiliation: Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Hidde M
authors.initials: HM
authors.lastname: Kroon
authors.affiliation: Melanoma Institute Australia, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.affiliation: Department of Surgery, Duke University, Durham, NC.
authors.forename: Neel
authors.initials: N
authors.lastname: Nath
authors.affiliation: Department of Surgery, Duke University, Durham, NC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mosca
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Farma
authors.affiliation: Department of Surgical Oncology, Marietta Memorial Hospital, Marietta, OH.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Bhati
authors.affiliation: Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hardmann
authors.affiliation: Morsani College of Medicine, University of South Florida, Tampa, FL.
authors.forename: Sean
authors.initials: S
authors.lastname: Sileno
authors.affiliation: Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Cristina
authors.initials: C
authors.lastname: O'Donoghue
authors.affiliation: Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Matthew
authors.initials: M
authors.lastname: Perez
authors.affiliation: Department of Biostatistics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Syeda Mahrukh Hussnain
authors.initials: SM
authors.lastname: Naqvi
authors.affiliation: Department of Biostatistics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Y Ann
authors.initials: YA
authors.lastname: Chen
authors.affiliation: Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Gonzalez
authors.affiliation: Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Zager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000379:methods*; D003609:Dactinomycin / Q000627:therapeutic use; D005121:Extremities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D003609:Dactinomycin; D008558:Melphalan