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Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma

Isolated Limb Infusion as a Limb Salvage Strategy for Locally Advanced Extremity Sarcoma content piece image

Limb threatening soft tissue sarcomas (STS) 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. We review perioperative and oncological outcomes and compare survival between ILI and amputation.

This is a multi-institutional retrospective review of ILI in patients with soft tissue extremity STS. Melphalan and actinomycin D were circulated for 30 minutes after complete tourniquet occlusion of the limb, then actively washed out to prevent systemic exposure. 

From 1994-2016, 67 patients underwent 74 ILIs at 3 different institutions. For ILI, 50.7% patients experienced complete or partial response at three months. The overall limb salvage rate was 77.6%. Patients with more severe limb toxicity (34.3%, Wieberdink III-IV) had higher response rates compared to those with less severe (65.7%, Wieberdink I-II) toxicity (p=0.006). Distant metastases free survival (DMFS) and overall survival (OS) were 14.5 months and 25.8 months, respectively for ILI versus 6.4 months and 18.5 months, respectively, in 72 patients who underwent amputation without previous ILI.

 ILI for extremity STS 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. Amputation did not show any improvement over ILI in oncological outcome or survival.