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Isolated Limb Infusion for Advanced Soft Tissue Sarcoma of the Extremity

¹ The Sydney Melanoma Unit, Gloucester House, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
² Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
³ Discipline of Anaesthetics, The University of Sydney, Sydney, NSW, Australia
⁴ Discipline of Pathology, The University of Sydney, Sydney, NSW, Australia

Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD; E-mail: john.thompson{at}smu.org.au

Background: Isolated limb infusion (ILI) is a minimally invasive technique for delivering high-dose regional chemotherapy. We report our experience with ILI for the treatment of soft tissue sarcoma (STS).

Methods: From our prospective database, 21 patients with STS of the limb treated with ILI between 1994 and 2007 were identified. In all patients, a high-dose cytotoxic drug combination was used.

Results: There were 14 men, and the median age was 60 years (range, 18–85 years). Eighteen patients (86%) had lower limb tumors. All patients had advanced local disease. The procedure was well tolerated. Fourteen patients (67%) received ILI before definitive surgery. The overall response rate was 90% (complete response [CR] rate 57%, partial response rate 33%). The disease-specific overall survival was 61.9% (median follow-up, 28 months). Only American Joint Committee on Cancer stage was associated with overall survival. The local recurrence rate was 42%. CR and malignant fibrous histiocytoma tumor subtype were associated with a lower local recurrence rate. A lower initial skin temperature (median 35.8°C) was associated with a CR (P = .033). Patients who had a steep increase in intramuscular temperature during the procedure were more likely to have a CR (P = .055). Classification tree analysis identified patients with an initial PaO₂ of 194 mmHg as being more likely to have a CR. Ultimately, the overall limb salvage rate was 76%.

Conclusion: The outcomes after ILI are comparable to those achieved by conventional isolated limb perfusion. ILI is a minimally invasive alternative to isolated limb perfusion for patients with advanced STS of the extremity.

Key Words: Isolated limb infusion • Soft tissue sarcoma • Melphalan • Actinomycin D • Regional chemotherapy