The use of isolated limb infusion in limb threatening extremity sarcomas

Figures & data

Table I.  Wieberdink Toxicity Scale.

Grade	Clinical characteristics
I	No subjective or objective evidence of reaction
II	Slight erythema or oedema
III	Considerable erythema or oedema with some blistering; slightly disturbed motility permissible
IV	Extensive epidermolysis or obvious damage to the deep tissues causing definite functional disturbances, threatened or manifest compartment syndromes
V	Reaction that may necessitate amputation

Table II.  Demographic characteristics of patients undergoing isolated limb infusion.

Variable	Overall	Upper extremity (N = 7)	Lower extremity (N = 19)
Number of infusions	26	7	19
Number of patients	22	6	16
Patients with single ILI	17	4	13
Patients with repeat ILI	4	1	3
Aborted ILI	1	1	0
Age, median, range, years	71 (19–93)	79 (54–93)	69 (55–71)
Female gender (% of total)	14 (64%)	4 (18%)	10 (45%)

Note: ILI, isolated limb infusion.

Table III.  Histological subtypes of sarcoma in patients undergoing isolated limb infusion.

Histological subtype	Number (%)
Undifferentiated pleomorphic sarcoma	9 (41%)
Myxoinflammatory fibroblastic sarcoma	4 (18%)
Synovial sarcoma	2 (9%)
Kaposis sarcoma	2 (9%)
Epithelioid sarcoma	1 (4.5%)
Leiomyosarcoma	1 (4.5%)
Angiosarcoma	1 (4.5%)
Alveolar rhabdomyosarcoma	1 (4.5%)
Fibrohistiocytic sarcoma	1 (4.5%)

Table IV.  Intraoperative and post-operative parameters for patients undergoing isolated limb infusions.

Variable	Overall (N = 26)	Upper extremity (N = 7)	Lower extremity (N = 19)	p-value
Limb volume, median, range, L	6.54 (1.4–11)	2.4 (1.4–3.0)	7.1 (6.5–10.3)	0.003
Melphalan dose, median, range, mg	34 (20–44)	19 (11.5–27)	38 (20–65)	0.002
Dactinomycin dose, median, range, mg	650 (140–900)	233 (140–300)	695 (320–900)	0.001
Melphalan dose adjusted for ideal body weight, %	96	100	95	NS
Papaverine use intraoperatively, %	100%	100%	100%	NS
Initial limb temp, Centigrade	38.5 (37.1–39.8)	38.5 (38.5–39.8)	38.5 (37.1–39.4)	NS
Temp at 30 min, Centigrade	39.5 (37.8–40.6)	39.7 (39.4–40.2)	39.4 (37.8–40.6)	NS
Perfusate blood gas at 30 min
PaO2, median, range, mmHg	10 (5–38)	15 (7–38)	9 (5–10)	0.02
pH, median, range	7.2 (6.97–7.28)	7.08 (7.06–7.25)	7.2 (6.97–7.28)	0.03
Base excess, median, range, mEq	−10 (−17, −3.8)	−15.3 (−16.5, −7.9)	−7.1 (−17, −3.8)	0.006
Ischaemia time, min, range	51 (46–73)	53.5 (44–60)	50.5 (47–73)	NS
Peak CPK, median, range, U/mL	455 (82–1058)	131 (69–184)	607 (93–1135)	NS
Day of CPK peak, median, range	4 (2–4.5)	2 (1.5–4)	4.5 (3–5.5)	0.02
Wieberdink toxicity				NS
Grade I–II	18 (69%)	6 (86%)	12 (63%)
Grade III	6 (23%)	0 (0%)	6 (37%)
Length of stay, days, range	6 (5–10)	5.5 (5–7)	6 (5–10)	NS

Note: CPK, Creatinine phosphokinase; NS, not significant.

Table V.  Response rates for patients undergoing isolated limb infusions.

Evaluable patients at 3 months post-ILI	Per infusion (%) N = 21	Per patient (%) N = 17
Overall response	42	42
Complete response	18	24
Partial response	24	18
Stable disease	14	18
Progressive disease	43	41
Resected to NED	9	12

Note: ILI, isolated limb infusion.

Table VI.  Response rates for patients undergoing isolated limb infusions stratified by extremity.*

Evaluable patients at 3 months post-ILI	Upper extremity (%) N = 3	Lower extremity (%) N = 14
Overall response	33	45
Complete response	33	17
Partial response	0	28
Stable disease	33	11
Progressive disease	33	44

Note: *No significant difference seen between overall response rate and complete response for upper extremity versus lower extremity.

ILI, isolated limb infusion.