Factors associated with response, survival, and limb salvage in patients undergoing isolated limb infusion

Background Isolated limb infusion (ILI) is a percutaneous method of delivering regional chemotherapy to patients with recurrent tumors of the extremity. This study determines predictors of response, survival, and limb salvage. Methods Single institution data from a prospective clinical trial and subsequent ILI experience were reviewed. Limb tumor burden was assessed in melanoma patients with “high” (≥10 lesions or one lesion >3 cm) or “low” burden (<10 lesions and no lesion >3 cm). Response was assessed at 3 months from ILI. Results Between 1999 and 2011, 62 patients underwent ILI (58 melanoma, 2 Merkel cell carcinoma (MCC), 2 soft tissue sarcoma (STS)). Low tumor burden patients had more complete responses (CR) (11/23, 48%) than high tumor burden (3/32, 9%, P  < 0.001); they had higher 5‐year survival (69% vs. 29%, P  = .007). Five‐year survival rates based on response: 91% CR, 53% partial response (PR), 25% less than PR ( P  = 0.042, CR vs. PR). 7 patients (11%) underwent amputation due to disease progression; 3 had prior CR or PR. Conclusions Low tumor burden is a significant predictor of response in melanoma patients. Response to ILI is a significant predictor of survival. Progression of limb disease requiring amputation is not associated with any factors. J. Surg. Oncol. 2014 109:405–409 . © 2013 Wiley Periodicals, Inc.