Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
Ann Surg Oncol. 2017 Dec;24(13):3842-3849. doi: 10.1245/s10434-017-6107-9. Epub 2017 Oct 10.
Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy to an extremity for patients with locally advanced cutaneous malignancies and sarcoma.
A single-institution, prospectively collected database was analyzed for intention-to-treat with ILI.
From 2007 to 2016, 163 patients underwent 205 procedures (201 were successfully completed), and four malignancies were treated: melanoma (72.1% of all ILIs), sarcoma (23.4%), squamous cell carcinoma (SCC; 2.0%) and Merkel cell carcinoma (MCC; 2.5%). A median grade II regional Wieberdink toxicity score was observed, with 88.1% of patients experiencing grade II or less. Median follow-up was 21.8 months, and overall response rate (ORR) was 59.0% for melanoma, 48.9% for sarcoma, 50.0% for SCC, and 60.0% for MCC. A significant difference (p = 0.04) between upper (76.9%) and lower extremity (55.1%) ORR was observed in patients with melanoma. When comparing responders with nonresponders, patients with melanoma had significantly longer in-field progression-free survival (IPFS; 14.1 vs. 3.2 months, p < 0.001), distant metastatic-free survival (DMFS; not reached vs. 25.8 months, p = 0.006), and overall survival (OS; 56.0 vs. 26.7 months, p = 0.0004). Sarcoma responders had a significantly longer IPFS (13.0 vs. 2.7 months, p < 0.0001), but no significant distant metastatic or OS advantage. Over a median follow-up of 19.3 months, sarcoma patients had an overall limb salvage rate of 68.4%.
ILI is a well-tolerated procedure for patients with locally advanced melanoma, sarcoma, and other cutaneous malignancies. ILI responders had a significantly longer time to IPFS, while melanoma responders also had a DMFS and OS advantage.
孤立肢体灌注（ILI）是一种将区域化疗递送至肢体以治疗局部晚期皮肤恶性肿瘤和肉瘤的微创技术。
对一家机构进行了前瞻性的、意向性治疗的数据库分析。
2007 年至 2016 年，163 名患者接受了 205 次治疗（201 次成功完成），其中四种恶性肿瘤得到了治疗：黑色素瘤（所有 ILI 的 72.1%）、肉瘤（23.4%）、鳞状细胞癌（2.0%）和 Merkel 细胞癌（2.5%）。观察到中位二级区域 Wieberdink 毒性评分，88.1%的患者出现二级或更低级别的毒性。中位随访时间为 21.8 个月，黑色素瘤的总缓解率（ORR）为 59.0%，肉瘤为 48.9%，鳞状细胞癌为 50.0%，Merkel 细胞癌为 60.0%。黑色素瘤患者上肢（76.9%）和下肢（55.1%）ORR 之间存在显著差异（p=0.04）。在比较反应者和非反应者时，黑色素瘤患者的瘤内无进展生存（IPFS）明显更长（14.1 与 3.2 个月，p<0.001），无远处转移生存（DMFS；未达到与 25.8 个月，p=0.006）和总生存（OS；56.0 与 26.7 个月，p=0.0004）。肉瘤反应者的 IPFS 明显更长（13.0 与 2.7 个月，p<0.0001），但无明显的远处转移或 OS 优势。在中位随访 19.3 个月后，肉瘤患者的肢体总体存活率为 68.4%。
ILI 是一种耐受良好的局部晚期黑色素瘤、肉瘤和其他皮肤恶性肿瘤患者的治疗方法。ILI 反应者的 IPFS 时间明显延长，而黑色素瘤反应者的 DMFS 和 OS 也有优势。
