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Clinical Response and Regional Toxicity Following Isolated Limb Infusion Compared with Isolated Limb Perfusion for In-Transit Melanoma

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

Abstract

Background

Isolated limb perfusion (ILP) and infusion (ILI) are therapeutic modalities for the treatment of in transit melanoma.

Methods

A retrospective review of all patients undergoing first-time ILI or ILP for in-transit melanoma metastases between 2007 and 2015 was performed. Demographic and clinical characteristics included age, sex, nodal status at the time of ILI/ILP (N-stage), and burden of disease (BOD). Regional toxicity was categorized by the Wieberdink classification. Clinical response was evaluated at 3 months after treatment.

Results

A total of 203 patients were reviewed (ILI = 94, ILP = 109). There were no differences in age, sex, or N-stage between groups; however, BOD was higher for the ILI group (high BOD 58 vs. 44 %, p = 0.04). Regional toxicity was minimal (Grade IV < 1 % in ILI and 2 % in ILP, p = 0.40). Overall response rate (ORR) was 53 % for ILI versus 80 % for ILP (p < 0.001). Median overall survival (OS) was 46 months for ILI versus 40 months for ILP (p = 0.31). A high BOD [hazard ratio (HR) 3.02, 95 % confidence interval (CI) 1.85–4.93, p < 0.001] and N3 disease (HR 1.58, 95 % CI 1.01–2.48, p = 0.04) were associated with worse OS, whereas there was no difference in OS by procedure (p = 0.20).

Conclusion

ILP offers an improved ORR, but this does not translate into improved local PFS or OS. Both procedures are well tolerated with minimal regional toxicity.

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Author notes

    Authors and Affiliations

    1. Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center, Tampa, FL, USA

      Lesly A. Dossett MD, MPH & Jonathan S. Zager MD, FACS

    2. Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden

      Ilan Ben-Shabat & Roger Olofsson Bagge MD, PhD

    Authors
    1. Lesly A. Dossett MD, MPH
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    2. Ilan Ben-Shabat
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    3. Roger Olofsson Bagge MD, PhD
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    4. Jonathan S. Zager MD, FACS
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    Correspondence to Jonathan S. Zager MD, FACS.

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    Lesly A. Dossett and Ilan Ben-Shabat have contributed equally to this work.

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    Dossett, L.A., Ben-Shabat, I., Olofsson Bagge, R. et al. Clinical Response and Regional Toxicity Following Isolated Limb Infusion Compared with Isolated Limb Perfusion for In-Transit Melanoma. Ann Surg Oncol 23, 2330–2335 (2016). https://doi.org/10.1245/s10434-016-5150-2

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