Australian Multicenter Study of Isolated Limb Infusion for Melanoma
- 370 Downloads
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.
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.
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.
- 1.Australian Institute of Health and Welfare, and Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Australian Cancer Incidence and Mortality Workbooks-Melanoma. Cancer series no. 74. Cat. no. CAN 70. Canberra: Australian Institute of Health and Welfare; 2012.Google Scholar
- 5.Thompson JF, Waugh RC, Saw RPM, et al. Isolated limb infusion with melphalan for recurrent limb melanoma: a simple alternative to isolated limb perfusion. Reg Cancer Treat. 1994;7:188–92.Google Scholar
- 13.Thompson JF, Kam PCA, de Wilt JHW, et al. Isolated limb infusion for melanoma. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 429–37.Google Scholar
- 17.Lai DTM, Ingvar C, Thompson JF. The value of monitoring serum creatine phosphokinase values following hyperthermic isolated limb perfusion for melanoma. Reg Cancer Treat. 1993;6:36–9.Google Scholar
- 18.World Health Organization. WHO handbook for reporting results of cancer treatments. WHO Offset Publication No. 48. Geneva: World Health Organization; 1979.Google Scholar
- 20.Cox DR. Regression models and life table. J Stat Soc. 1972;34:187–220.Google Scholar
- 26.Vrouenraets BC, Kroon BBR, Nieweg OE, et al. Isolated limb perfusion for melanoma: results and complications, toxicity. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 410–28.Google Scholar