Isolated Limb Perfusion for Melanoma is Safe and Effective in Elderly Patients

  • Max F. Madu
  • Marion M. Deken
  • Jos A. van der Hage
  • Katarzyna Jóźwiak
  • Michel W. J. M. Wouters
  • Alexander C. J. van Akkooi
Melanomas

DOI: 10.1245/s10434-017-5803-9

Cite this article as:
Madu, M.F., Deken, M.M., van der Hage, J.A. et al. Ann Surg Oncol (2017). doi:10.1245/s10434-017-5803-9
  • 32 Downloads

Abstract

Background

Data on isolated limb perfusion (ILP) in elderly melanoma patients are scarce. We aimed to evaluate the efficacy and safety of ILP in our institutional cohort of melanoma patients.

Methods

We performed retrospective analysis of stage IIIB/C melanoma patients who underwent ILP for melanoma in-transit metastases (ITMs) in our institution between 2000 and 2016. Normothermic ILP was performed with either melphalan or melphalan and tumor necrosis factor. Baseline and treatment characteristics, locoregional progression-free survival (LPFS) and melanoma-specific survival (MSS) were assessed and prognostic factors for response, recurrence, and survival were analyzed using univariable and multivariable analysis.

Results

Overall, 91 patients were included in this study. Based on the median age of 70 years, we split patients into younger and elderly groups. No differences in response rates were observed between age groups, with an overall response rate of 81% and complete response (CR) rate of 47%. LPFS did not differ between age groups, and median LPFS was 16 months for patients with a CR. Median MSS was 38 months and differed between younger (45 months) and elderly patients (18 months). Toxicity was generally mild and did not differ between age groups. Two patients (2.2%) suffered Wieberdink IV toxicity, while no patients required amputation because of severe toxicity. CR was prognostic for improved LPFS and MSS, while patients >70 years of age and patients with stage IIIC disease had a higher risk of melanoma-specific death.

Conclusions

Because of its safety profile and high CR rates, ILP is a viable option for patients with bulky or multiple melanoma ITMs, including elderly (>70 years of age) patients.

Supplementary material

10434_2017_5803_MOESM1_ESM.docx (18 kb)
Supplementary material 1 (DOCX 17 kb)
10434_2017_5803_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 13 kb)

Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Max F. Madu
    • 1
  • Marion M. Deken
    • 1
  • Jos A. van der Hage
    • 1
  • Katarzyna Jóźwiak
    • 2
  • Michel W. J. M. Wouters
    • 1
  • Alexander C. J. van Akkooi
    • 1
  1. 1.Department of Surgical OncologyNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands
  2. 2.Department of Epidemiology and BiostatisticsNetherlands Cancer Institute – Antoni van LeeuwenhoekAmsterdamThe Netherlands