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Updated: May 21, 2026
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Minimally Invasive Isolated Limb Perfusion (MI-ILP) for Locally Advanced Melanomas and Sarcomas of the Extremity
Published on: January 31, 2025
A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower
Georgia M Beasley1, Ketan Sharma, Joyce Wong
1Department of Surgical Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Cancer
|June 8, 2012
Summary
Isolated limb infusion (ILI) for upper extremity (UE) disease shows similar cancer response rates but significantly lower toxicity compared to lower extremity (LE) ILI. This suggests potential for optimizing melphalan dosing in UE ILI.
Area of Science:
- Oncology
- Surgical Oncology
- Pharmacology
Background:
- Studies often combine upper extremity (UE) and lower extremity (LE) isolated limb infusion (ILI) data, potentially masking critical differences.
- Melphalan-based ILI is a key treatment modality for advanced limb malignancies.
Purpose of the Study:
- To compare the clinical outcomes and physiological effects of melphalan-based ILI between UE and LE disease.
- To identify potential differences in toxicity and response rates between UE and LE ILI.
Main Methods:
- Retrospective analysis of 51 UE ILI and 192 LE ILI cases from prospective databases.
- Utilized Response Evaluation Criteria in Solid Tumors (RECIST) for response assessment and Wieberdink toxicity scale for adverse events.
- Analyzed perfusate blood gas parameters, limb volumes, melphalan doses, and ischemic times.
Main Results:
- UE ILI patients had significantly lower limb volumes and melphalan doses compared to LE ILI patients.
- UE ILI procedures exhibited distinct physiological changes, including lower mean base excess and pH, despite shorter ischemic times.
- Regional toxicity (grade ≥3) was significantly lower in UE ILI (7%) versus LE ILI (24%).
- Complete response rates for melanoma were comparable between UE (28%) and LE (32%) ILI.
Conclusions:
- Melphalan-based ILI for UE disease achieves similar response rates to LE ILI but with substantially reduced toxicity.
- The upper extremity appears relatively resistant to melphalan toxicity during ILI.
- Findings suggest an opportunity to optimize melphalan dosing strategies for UE ILI.
