Isolated limb perfusion and infusion in the treatment of melanoma and soft tissue sarcoma in the era of modern systemic therapies

Abstract

Background and Objectives Isolated limb perfusion (ILP) and infusion (ILI) are treatment modalities for unresectable melanoma in‐transit metastases and extremity soft tissue sarcomas (STS). We sought to characterize the national trend in their utilization in the context of novel melanoma therapies introduced in 2011. Methods Using the National Inpatient Sample (2005‐2014), patients with a primary diagnosis of limb melanoma or STS who underwent ILP/ILI were identified by diagnosis and procedure codes. Annual percent change (APC) in ILP/ILI procedures was determined. Results From 2005 through 2014, 670 and 130 ILP/ILI procedures were performed for melanoma and STS, respectively. Mean age was 64 (SD 15) years for melanoma and 59 (SD 18) years for STS. Over time, procedures for melanoma decreased with an APC of ‐17 (P = .019). Comparing 2005‐2010 and 2011‐2014, the mean number of procedures for melanoma decreased from 91 to 32 per year (P = .007). In contrast, there was no change for STS (APC 6.5, P = .39; mean 11 and 16 per year in 2005‐2010 and 2011‐2014, respectively, P = .46). Conclusions ILI/ILP utilization has decreased for melanoma, but not for STS. Whether trends for ILP and ILI differed could not be determined. ILP/ILI remains an important option to consider for regional disease control.

Imaging response evaluation after neoadjuvant treatment in soft tissue sarcomas: Where do we stand?

“…Neoadjuvant chemo-radiation is a combined strategy for poorly resectable tumours with synergic effects and the potential to lower required RT doses (Look Hong et al, 2013;Spałek et al, 2020;Lehane et al, 2016). Hyperthermic isolated limb perfusion is a further neoadjuvant approach, and can be considered an alternative to amputation in specific circumstances (Song et al, 2019).…”

Gene Therapeutic Strategies for Peripheral Artery Disease and New Opportunities Provided by Adeno-Associated Virus Vectors

“…This has been used to deliver high concentrations of chemotherapeutic drugs to a limb temporarily isolated from the circulation. 94 Limited animal studies have also examined RI to deliver AAV. For example, a study using AAV1, AAV6, and AAV8 to deliver microdystrophin in mice and AAV8-EGFP in macaques showed successful intravascular gene delivery to muscle cells with AAV6 and AAV8.…”

Xeroderma Pigmentosum: A Genetic Condition Skin Cancer Correlated—A Systematic Review

“…A particular variant of chemotherapy is the isolated limb perfusion (ILP) [ 53 ] which consists of the perfusion of a limb isolated from the systemic circulation and connected to an extracorporeal system.…”