Abstract
Background
Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation.
Methods
From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20–30 min under mild hyperthermic conditions (38–39°C).
Results
The majority of patients (62%) were female. Their average age was 74 years (range 29–93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable outcome were achievement of CR, stage of disease, thickness of primary melanoma, the CO2 level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema).
Conclusion
The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.
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Acknowledgements
Hidde Kroon was supported by grants from Haak Bastiaanse–Kuneman Stichting, Stichting Fundatie van de Vrijvrouwe van Renswoude te ‘s-Gravenhage, Stichting Noordelijk Chirurgisch Oncologisch Fonds, Stichting Sacha Swarttouw-Heijmans, KWF Kankerbestrijding, Stichting Prof. Michaël-van Vloten Fonds, Amgen Netherlands BV, University Medical Center Groningen/Faculty of Medical Sciences of the University of Groningen, and the Melanoma Foundation of the University of Sydney.
Marc Moncrieff was the inaugural Greg Poche Fellow at the Sydney Melanoma Unit and was also supported by a grant from the Melanoma Foundation of the University of Sydney.
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Kroon, H.M., Moncrieff, M., Kam, P.C.A. et al. Outcomes Following Isolated Limb Infusion for Melanoma. A 14-Year Experience. Ann Surg Oncol 15, 3003–3013 (2008). https://doi.org/10.1245/s10434-008-9954-6
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DOI: https://doi.org/10.1245/s10434-008-9954-6