Quality of life outcomes after isolated limb infusion

Ann Surg Oncol. 2012 May;19(5):1373-8. doi: 10.1245/s10434-012-2239-0.

Abstract

Background: Isolated limb infusion (ILI) for the treatment of in-transit melanoma was originally described more than 10 years ago. Response rates of 45-53% have been reported in U.S. series. Long-term quality of life outcomes after this procedure have not been described. We hypothesized that ILI is rarely associated with long-term limb morbidity.

Methods: ILIs performed at our institution between July 2005 and June 2009 were reviewed. Patients were contacted cross-sectionally at 2 time points. During these interviews, response to treatment and postoperative limb function were assessed.

Results: Thirty-two ILIs were performed during the time period. Twenty-seven patients were treated for in-transit melanoma; 5 were treated for recurrent Merkel cell carcinoma. The 30-day mortality was 0%. Three patients (9%) required fasciotomy. Durable complete responses were achieved in 41% of patients, with mean follow-up time of 19.4 ± 9.6 months after infusion; after this period, 53% reported progression of disease. The most common postprocedure symptoms were edema (88%), numbness (59%), and pain (59%). By 3 months and at the time of last follow-up, the most common symptoms were edema (82%), numbness (65%), and stiffness (35%). No patients reported impaired limb function at the time of last follow-up compared to baseline. Median survival was 19.2 ± 4.2 months after infusion.

Conclusions: ILI for melanoma and Merkel cell carcinoma is associated with postprocedure symptoms in most patients, most commonly edema, color change, and numbness. At last follow-up, no ILI patients had residual functional impairment in the treated limb.

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Arm
  • Carcinoma, Merkel Cell / drug therapy
  • Carcinoma, Merkel Cell / psychology
  • Cross-Sectional Studies
  • Dactinomycin / administration & dosage
  • Edema / etiology
  • Edema / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Hypesthesia / etiology
  • Hypesthesia / psychology
  • Infusions, Intravenous
  • Leg
  • Length of Stay
  • Male
  • Melanoma / drug therapy*
  • Melanoma / psychology*
  • Melphalan / administration & dosage
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / psychology
  • Quality of Life*
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / psychology*
  • Survival Rate

Substances

  • Dactinomycin
  • Melphalan