Repeated Isolated Limb Infusion as Limb Salvage Therapy for Recurrent Unresectable Extremity Sarcoma

Leah E. Hendrick, David Portnoy, Michael Neel, Martin D. Fleming and Jeremiah L. Deneve DO

Department of Surgery, University of Tennessee Health Science Center, USA
Department of Surgical Oncology, University of Tennessee Health Science Center, USA
Department of West Cancer Center, University of Tennessee Health Science Center, USA
Ortho Memphis, Memphis, TN, USA

^*Correspondance to: Jeremiah L. Deneve DO 

 PDF  Full Text Case Report | Open Access

Abstract:

Introduction: Recurrent Soft Tissue Sarcoma (STS) of the extremity remains a difficult challenge. Isolated Limb Infusion (ILI) is a treatment option for patients with unrespectable extremity STS who would otherwise require amputation. We present a case of recurrent extremity sarcoma managed with ILI as a limb-salvage alternative to amputation.Methods: We present a case of recurrent extremity sarcoma managed with repeated ILI and a brief review of the literature.Case Report: A 34 year old male presented in July 2013 as a referral for forequarter amputation for management of unresectable recurrent left upper extremity sarcoma. At initial presentation in 2011, the tumor involved the median nerve. Neoadjuvant radiation was administered and a microscopic margin positive resection of a single left forearm lesion was performed. The patient developed multifocal recurrence in 2013 with lesions involving the initial left forearm site, the left upper extremity along the biceps tendon, a left clavicular lesion and left axillary lymphadenopathy. CT imaging of the chest demonstrated no evidence of distant disease. Resection of the multiple recurrences was performed followed by ILI. A partial response to ILI was initially observed. Additional disease developed 9 months after ILI and repeat ILI was performed. Forequarter amputation was ultimately required for local control of additional multifocal recurrence, 16 months after initial ILI. Distant disease eventually developed to which the patient succumbed in late 2015.Conclusion: Management of recurrent extremity STS remains a difficult challenge. Repeated ILI offers an alternative to amputation for selected patients while maintaining function and quality of life.

Keywords:

Sarcoma; Isolated Limb Infusion; Weiberdink; Recurrence; Amputation

Cite the Article:

Hendrick LE, Portnoy D, Neel M, Fleming MD, Jeremiah L Deneve DO. Repeated Isolated Limb Infusion as Limb Salvage Therapy for Recurrent Unresectable Extremity Sarcoma. Clin Oncol. 2018; 3: 1400.