Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms

Kiran K. Turaga, Georgia M. Beasley, John M. Kane, Keith A. Delman, Stephen R. Grobmyer, Ricardo J. Gonzalez, G. Douglas Letson, David Cheong, Douglas Tyler, Jonathan S. Zager

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: To demonstrate the efficacy of isolated limb infusion (ILI) in limb preservation for patients with locally advanced soft-tissue sarcomas and nonmelanoma cutaneous malignant neoplasms. Background: Locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms, including softtissue sarcomas of the extremities, can pose significant treatment challenges. We report our experience, including responses and limb preservation rates, using ILI in cutaneous and soft-tissue malignant neoplasms. Methods: We identified 22 patients with cutaneous and soft-tissue malignant neoplasms who underwent 26 ILIs with melphalan and dactinomycin from January 1, 2004, through December 31, 2009, from 5 institutions. Outcome measures included limb preservation and in-field response rates. Regional toxic effects were measured using the Wieberdink scale and serum creatinine phosphokinase levels. Results: The median age was 70 years (range, 19-92 years), and 12 patients (55%) were women. Fourteen patients (64%) had sarcomas, 7 (32%) had Merkel cell carcinoma, and 1 (5%) had squamous cell carcinoma. The median length of stay was 5.5 days (interquartile range, 4-8 days). Twenty-five of the 26 ILIs (96%) resulted in Wieberdink grade III or less toxicity, and 1 patient (4%) developed grade IV toxicity. The median serum creatinine phosphokinase level was 127 U/L for upper extremity ILIs and 93 U/L for lower extremity ILIs. Nineteen of 22 patients (86%) underwent successful limb preservation. The 3-month in-field response rate was 79% (21% complete and 58% partial), and the median follow-up was 8.6 months (range, 1-63 months). Five patients underwent resection of disease after an ILI, of whom 80% are disease free at a median of 8.6 months. Conclusions: Isolated limb infusion provides an attractive alternative therapy for regional disease control and limb preservation in patients with limb-threatening cutaneous and soft-tissue malignant neoplasms. Short-term response rates appear encouraging, yet durability of response is unknown.

Original languageEnglish (US)
Pages (from-to)870-875
Number of pages6
JournalArchives of Surgery
Volume146
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

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Soft Tissue Neoplasms
Extremities
Skin
Sarcoma
Creatinine
Phosphotransferases
Merkel Cell Carcinoma
Melphalan
Poisons
Dactinomycin
Skin Neoplasms
Complementary Therapies
Serum
Upper Extremity
Squamous Cell Carcinoma
Lower Extremity
Length of Stay

ASJC Scopus subject areas

  • Surgery

Cite this

Turaga, K. K., Beasley, G. M., Kane, J. M., Delman, K. A., Grobmyer, S. R., Gonzalez, R. J., ... Zager, J. S. (2011). Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms. Archives of Surgery, 146(7), 870-875. https://doi.org/10.1001/archsurg.2011.139

Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms. / Turaga, Kiran K.; Beasley, Georgia M.; Kane, John M.; Delman, Keith A.; Grobmyer, Stephen R.; Gonzalez, Ricardo J.; Letson, G. Douglas; Cheong, David; Tyler, Douglas; Zager, Jonathan S.

In: Archives of Surgery, Vol. 146, No. 7, 07.2011, p. 870-875.

Research output: Contribution to journalArticle

Turaga, KK, Beasley, GM, Kane, JM, Delman, KA, Grobmyer, SR, Gonzalez, RJ, Letson, GD, Cheong, D, Tyler, D & Zager, JS 2011, 'Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms', Archives of Surgery, vol. 146, no. 7, pp. 870-875. https://doi.org/10.1001/archsurg.2011.139
Turaga, Kiran K. ; Beasley, Georgia M. ; Kane, John M. ; Delman, Keith A. ; Grobmyer, Stephen R. ; Gonzalez, Ricardo J. ; Letson, G. Douglas ; Cheong, David ; Tyler, Douglas ; Zager, Jonathan S. / Limb preservation with isolated limb infusion for locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms. In: Archives of Surgery. 2011 ; Vol. 146, No. 7. pp. 870-875.
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abstract = "Objective: To demonstrate the efficacy of isolated limb infusion (ILI) in limb preservation for patients with locally advanced soft-tissue sarcomas and nonmelanoma cutaneous malignant neoplasms. Background: Locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms, including softtissue sarcomas of the extremities, can pose significant treatment challenges. We report our experience, including responses and limb preservation rates, using ILI in cutaneous and soft-tissue malignant neoplasms. Methods: We identified 22 patients with cutaneous and soft-tissue malignant neoplasms who underwent 26 ILIs with melphalan and dactinomycin from January 1, 2004, through December 31, 2009, from 5 institutions. Outcome measures included limb preservation and in-field response rates. Regional toxic effects were measured using the Wieberdink scale and serum creatinine phosphokinase levels. Results: The median age was 70 years (range, 19-92 years), and 12 patients (55{\%}) were women. Fourteen patients (64{\%}) had sarcomas, 7 (32{\%}) had Merkel cell carcinoma, and 1 (5{\%}) had squamous cell carcinoma. The median length of stay was 5.5 days (interquartile range, 4-8 days). Twenty-five of the 26 ILIs (96{\%}) resulted in Wieberdink grade III or less toxicity, and 1 patient (4{\%}) developed grade IV toxicity. The median serum creatinine phosphokinase level was 127 U/L for upper extremity ILIs and 93 U/L for lower extremity ILIs. Nineteen of 22 patients (86{\%}) underwent successful limb preservation. The 3-month in-field response rate was 79{\%} (21{\%} complete and 58{\%} partial), and the median follow-up was 8.6 months (range, 1-63 months). Five patients underwent resection of disease after an ILI, of whom 80{\%} are disease free at a median of 8.6 months. Conclusions: Isolated limb infusion provides an attractive alternative therapy for regional disease control and limb preservation in patients with limb-threatening cutaneous and soft-tissue malignant neoplasms. Short-term response rates appear encouraging, yet durability of response is unknown.",
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AU - Beasley, Georgia M.

AU - Kane, John M.

AU - Delman, Keith A.

AU - Grobmyer, Stephen R.

AU - Gonzalez, Ricardo J.

AU - Letson, G. Douglas

AU - Cheong, David

AU - Tyler, Douglas

AU - Zager, Jonathan S.

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N2 - Objective: To demonstrate the efficacy of isolated limb infusion (ILI) in limb preservation for patients with locally advanced soft-tissue sarcomas and nonmelanoma cutaneous malignant neoplasms. Background: Locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms, including softtissue sarcomas of the extremities, can pose significant treatment challenges. We report our experience, including responses and limb preservation rates, using ILI in cutaneous and soft-tissue malignant neoplasms. Methods: We identified 22 patients with cutaneous and soft-tissue malignant neoplasms who underwent 26 ILIs with melphalan and dactinomycin from January 1, 2004, through December 31, 2009, from 5 institutions. Outcome measures included limb preservation and in-field response rates. Regional toxic effects were measured using the Wieberdink scale and serum creatinine phosphokinase levels. Results: The median age was 70 years (range, 19-92 years), and 12 patients (55%) were women. Fourteen patients (64%) had sarcomas, 7 (32%) had Merkel cell carcinoma, and 1 (5%) had squamous cell carcinoma. The median length of stay was 5.5 days (interquartile range, 4-8 days). Twenty-five of the 26 ILIs (96%) resulted in Wieberdink grade III or less toxicity, and 1 patient (4%) developed grade IV toxicity. The median serum creatinine phosphokinase level was 127 U/L for upper extremity ILIs and 93 U/L for lower extremity ILIs. Nineteen of 22 patients (86%) underwent successful limb preservation. The 3-month in-field response rate was 79% (21% complete and 58% partial), and the median follow-up was 8.6 months (range, 1-63 months). Five patients underwent resection of disease after an ILI, of whom 80% are disease free at a median of 8.6 months. Conclusions: Isolated limb infusion provides an attractive alternative therapy for regional disease control and limb preservation in patients with limb-threatening cutaneous and soft-tissue malignant neoplasms. Short-term response rates appear encouraging, yet durability of response is unknown.

AB - Objective: To demonstrate the efficacy of isolated limb infusion (ILI) in limb preservation for patients with locally advanced soft-tissue sarcomas and nonmelanoma cutaneous malignant neoplasms. Background: Locally advanced nonmelanoma cutaneous and soft-tissue malignant neoplasms, including softtissue sarcomas of the extremities, can pose significant treatment challenges. We report our experience, including responses and limb preservation rates, using ILI in cutaneous and soft-tissue malignant neoplasms. Methods: We identified 22 patients with cutaneous and soft-tissue malignant neoplasms who underwent 26 ILIs with melphalan and dactinomycin from January 1, 2004, through December 31, 2009, from 5 institutions. Outcome measures included limb preservation and in-field response rates. Regional toxic effects were measured using the Wieberdink scale and serum creatinine phosphokinase levels. Results: The median age was 70 years (range, 19-92 years), and 12 patients (55%) were women. Fourteen patients (64%) had sarcomas, 7 (32%) had Merkel cell carcinoma, and 1 (5%) had squamous cell carcinoma. The median length of stay was 5.5 days (interquartile range, 4-8 days). Twenty-five of the 26 ILIs (96%) resulted in Wieberdink grade III or less toxicity, and 1 patient (4%) developed grade IV toxicity. The median serum creatinine phosphokinase level was 127 U/L for upper extremity ILIs and 93 U/L for lower extremity ILIs. Nineteen of 22 patients (86%) underwent successful limb preservation. The 3-month in-field response rate was 79% (21% complete and 58% partial), and the median follow-up was 8.6 months (range, 1-63 months). Five patients underwent resection of disease after an ILI, of whom 80% are disease free at a median of 8.6 months. Conclusions: Isolated limb infusion provides an attractive alternative therapy for regional disease control and limb preservation in patients with limb-threatening cutaneous and soft-tissue malignant neoplasms. Short-term response rates appear encouraging, yet durability of response is unknown.

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