Annals of Surgical Oncology

, Volume 23, Issue 4, pp 1096–1103 | Cite as

Australian Multicenter Study of Isolated Limb Infusion for Melanoma

  • Hidde M. Kroon
  • Brendon J. Coventry
  • Mitchell H. Giles
  • Michael A. Henderson
  • David Speakman
  • Mark Wall
  • Andrew Barbour
  • Jonathan Serpell
  • Paul Paddle
  • Alexander G. J. Coventry
  • Thomas Sullivan
  • Bernard Mark Smithers
  • John F. Thompson
Melanomas

Abstract

Purpose

Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting.

Patients and Methods

The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale.

Results

The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months (p = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival.

Conclusions

This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Hidde M. Kroon
    • 1
    • 6
  • Brendon J. Coventry
    • 1
  • Mitchell H. Giles
    • 1
  • Michael A. Henderson
    • 2
  • David Speakman
    • 2
  • Mark Wall
    • 2
  • Andrew Barbour
    • 3
  • Jonathan Serpell
    • 4
  • Paul Paddle
    • 4
  • Alexander G. J. Coventry
    • 1
  • Thomas Sullivan
    • 5
  • Bernard Mark Smithers
    • 3
  • John F. Thompson
    • 6
    • 7
    • 8
  1. 1.Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideAustralia
  2. 2.Division of Surgical Oncology, Department of Surgery, Peter MacCallum Cancer CentreUniversity of MelbourneMelbourneAustralia
  3. 3.Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra HospitalUniversity of QueenslandBrisbaneAustralia
  4. 4.Discipline of SurgeryThe Alfred HospitalMelbourneAustralia
  5. 5.Statistics, Data Management and Analysis Centre, Discipline of Public HealthUniversity of AdelaideAdelaideAustralia
  6. 6.Melanoma Institute AustraliaSydneyAustralia
  7. 7.Discipline of SurgeryThe University of SydneySydneyAustralia
  8. 8.Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalCamperdownAustralia

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