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Major Amputation for Irresectable Extremity Melanoma After Failure of Isolated Limb Infusion

  • Melanomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Isolated limb infusion (ILI) is an effective, minimally invasive treatment option that delivers high-dose regional chemotherapy to treat metastatic melanoma confined to a limb. In some patients, however, locoregional disease does not respond to the treatment or extensive recurrence occurs so that an amputation may become inevitable. In this study we analyzed indications for and results of amputation in these cases.

Methods

14 patients were identified in whom amputation of the affected limb had to be carried out after failure of ILI.

Results

Following ILI, three patients had a complete response, seven had a partial response, two had stable disease and two patients had progressive disease. The median duration of response after ILI was 7 months (range 2–30). The median interval between ILI and amputation was 10 months. Amputation was performed in six of 20 patients who had been treated with an upper limb ILI, compared to eight amputations that were performed in 215 patients who had been treated with a lower limb ILI (P = .001). The indications for amputation were severe pain due to progression of tumor (n = 3), uncontrollable and troublesome tumor progression (n = 6) and bleeding from ulcerated lesions (n = 5). Five patients developed stump recurrence after amputation; these were treated by excision or radiation. Six of the eight patients who had a lower limb amputation became ambulant with the aid of prosthesis. Median survival after amputation was 13 months: three patients survived more than 5 years.

Conclusions

Amputation following upper extremity ILI is more common compared to lower extremity ILI. Amputation may provide effective long-term palliation in selected patients when there is extensive inoperable progressive or recurrent disease after ILI.

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Acknowledgments

Hidde Kroon is supported by grants from, Haak Bastiaanse-Kuneman Stichting, Stichting Fundatie van de Vrijvrouwe van Renswoude te ‘s-Gravenhage, 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, the Melanoma Foundation of the University of Sydney and Melanoma Institute Australia.

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Authors and Affiliations

  1. Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Hidde M. Kroon MD, D-Yin Lin MD & John F. Thompson MD

  2. Department of Anaesthetics, Royal Prince Alfred Hospital and Discipline of Anaesthetics, The University of Sydney, Sydney, NSW, Australia

    Peter C. A. Kam MD

  3. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MD

Authors
  1. Hidde M. Kroon MD
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  2. D-Yin Lin MD
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  3. Peter C. A. Kam MD
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  4. John F. Thompson MD
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Corresponding author

Correspondence to Hidde M. Kroon MD.

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Kroon, H.M., Lin, DY., Kam, P.C.A. et al. Major Amputation for Irresectable Extremity Melanoma After Failure of Isolated Limb Infusion. Ann Surg Oncol 16, 1543–1547 (2009). https://doi.org/10.1245/s10434-009-0394-8

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