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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery ISOLATED LIMB INFUSION:
A NOVEL TREATMENT FOR LOCALLY ADVANCED SOFT TISSUE SARCOMA OF THE
EXTREMITY. OBJECTIVE: Isolated limb infusion (ILI) is a technique of delivering regional chemotherapy to the extremity in patients with advanced melanoma or soft tissue sarcoma (STS). ILI is performed by administering high doses of chemotherapy into a normothermic, hypoxic, and low flow circuit via angiographically placed catheters after a tourniquet is placed around the proximal extremity. Unlike the standard approach of isolated limb perfusion (ILP), no surgical incision is required. In addition, the procedure is less time consuming, lends itself to repeat treatments and is associated, in our initial experience, with a shortened hospital stay and less morbidity than conventional ILP. METHODS: We report our experience with a 60 year old man who presented with a rapidly growing, high grade STS of the calf. The tumor was unresectable other than by amputation due to encasement of the nerves and vasculature. The patient was treated with neoadjuvant chemotherapy (high dose adriamycin and ifosfamide) and progressed on this regime (see figure). The patient underwent ILI with melphalan and dactinomycin and had significant tumor shrinkage resulting in restoration of his dorsalis pedis pulse. A second ILI was performed 10 weeks later resulting in a decrease in the dimensions of his tumor by MRI from 12.2cm x 7.8cm prior to the first infusion to 5.5cm x 7.3cm 8 weeks after his second (see figure). The patient remains without systemic disease, and 23 weeks after his initial ILI has experienced no significant morbidity from his regional therapy. RESULTS: Figure: Tumor volume by MRI in relation to treatment. CONCLUSION: ILI using melphalan and dactinomycin may be an effective means of regional control in patients with unresectable STS with less morbidity than ILP.
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