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Safety and efficacy of isolated limb perfusion in elderly melanoma patients

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Abstract

Background

Older patients are assumed to have a higher risk of complications from isolated limb perfusion (ILP). A study was performed evaluating the safety and efficacy of ILP in patients older than 75 years with advanced melanoma of the limbs.

Methods

A total of 218 therapeutic ILPs with melphalan with or without tumor necrosis factor α were performed in 202 patients with advanced measurable melanoma and were analyzed retrospectively. Fifty-three patients (28%) were 75 years or older.

Results

Complete response rates were 56% for those older than 75 years and 58% for the younger group (P=.79). Locoregional relapse occurred in 56% of the older group versus 51% in the younger group (P=.61). Limb toxicity, systemic toxicity, local complications, and long-term morbidity were similar in both age groups. Perioperative mortality was low, with one procedure-related death in the older group. Older patients stayed in the hospital for a median of 23 days (younger patients, 19 days;P<.01).

Conclusions

ILP results in similar response rates in the elderly with recurrent melanoma, without increased toxicity, complications, or long-term morbidity compared with younger patients. Older age in itself is not a contraindication for ILP.

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References

  1. Vrouenraets BC, Nieweg OE, Kroon BBR. Thirty-five years of isolated limb perfusion for melanoma: indications and results.Br J Surg 1996;83:1319–28.

    Article  PubMed  CAS  Google Scholar 

  2. Eggermont AMM, Schraffordt Koops H, Kroon BBR, et al. Isolated limb perfusion with high-dose tumor necrosis factor-alpha in combination with interferon-gamma and melphalan for nonresectable extremity soft tissue sarcomas: a multicenter trial.J Clin Oncol 1996;14:2653–65.

    PubMed  CAS  Google Scholar 

  3. Fraker DL, Alexander HR, Andrich M, Rosenberg SA. Treatment of patients with melanoma of the extremity using hyperthermic isolated limb perfusion with melphalan, tumor necrosis factor, and interferon gamma: results of a tumor necrosis factor dose-escalation study.J Clin Oncol 1996;14:479–89.

    PubMed  CAS  Google Scholar 

  4. Fraker DL, Alexander HR, Andrich M, et al. Palliation of regional symptoms of advanced extremity melanoma by isolated limb perfusion with melphalan and high-dose tumor necrosis factor.Cancer J Sci Am 1995;1:122.

    PubMed  CAS  Google Scholar 

  5. Bartlett DL, Grace M, Alexander HR, Libutti SK, Fraker DL. Isolated limb perfusion with tumor necrosis factor and melphalan in patients with extremity melanoma after failure of isolated limb perfusion with chemotherapeutics.Cancer 1997;80:2084–90.

    Article  PubMed  CAS  Google Scholar 

  6. Sonneveld EJ, Vrouenraets BC, van Geel BN, et al. Systemic toxicity after isolated limb perfusion with melphalan for melanoma.Eur J Surg Oncol 1996;22:521–7.

    Article  PubMed  CAS  Google Scholar 

  7. Vrouenraets BC, Kroon BBR, Ogilvie AC, et al. Absence of severe systemic toxicity after leakage-controlled isolated limb perfusion with tumor necrosis factor-alpha and melphalan.Ann Surg Oncol 1999;6:405–12.

    Article  PubMed  CAS  Google Scholar 

  8. Vrouenraets BC, Eggermont AMM, Hart AA, et al. Regional toxicity after isolated limb perfusion with melphalan and tumor necrosis factor-alpha versus toxicity after melphalan alone.Eur J Surg Oncol 2001;27:390–5.

    Article  PubMed  CAS  Google Scholar 

  9. Thomas DR, Ritchie CS. Preoperative assessment of older adults.J Am Geriatr Soc 1995;43:811–21.

    PubMed  CAS  Google Scholar 

  10. Polanczyk CA, Marcantonio E, Goldman L, et al. Impact of age on peri-operative complications and length of stay in patients undergoing noncardiac surgery.Ann Intern Med 2001;134:637–43.

    PubMed  CAS  Google Scholar 

  11. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients.Lancet 1995;345:745–8.

    Article  PubMed  CAS  Google Scholar 

  12. Hobler KE. Colon surgery for cancer in the very elderly. Cost and 3-year survival.Ann Surg 1986;203:129–31.

    Article  PubMed  CAS  Google Scholar 

  13. Vrouenraets BC, Klaase JM, Kroon BBR, Van Geel BN, Eggermont AMM, Franklin HR. Long-term morbidity after regional isolated perfusion with melphalan for melanoma of the limbs. The influence of acute regional toxic reactions.Arch Surg 1995;130:43–7.

    PubMed  CAS  Google Scholar 

  14. Liénard D, Ewalenko P, Delmotte JJ, Renard N, Lejeune FJ. High-dose recombinant tumor necrosis factor alpha in combination with interferon gamma and melphalan in isolation perfusion of the limbs for melanoma and sarcoma.J Clin Oncol 1992;10:52–60.

    PubMed  Google Scholar 

  15. Wieberdink J, Benckhuijsen C, Braat RP, van Slooten EA, Olthuis GA. Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions.Eur J Cancer Clin Oncol 1982;18:905–10.

    Article  PubMed  CAS  Google Scholar 

  16. World Health Organization.WHO Handbook for Reporting Results of Cancer Treatment. Geneva: Word Health Organization. 1979.

    Google Scholar 

  17. Zenilman ME. Surgery in the elderly.Curr Probl Surg 1998;35:99–179.

    Article  PubMed  CAS  Google Scholar 

  18. Eggermont AMM. Treatment of melanoma in-transit metastases confined to the limb.Cancer Surv 1996;26:335–49.

    PubMed  CAS  Google Scholar 

  19. Schraffordt Koops H, Garbe C, Hohenberger P. Is isolated limb perfusion of metastatic malignant melanoma of the extremity worthwhile?Eur J Cancer 1996;32A:1633–40.

    Article  Google Scholar 

  20. Ariyan S, Poo WJ. Safety and efficacy of isolated perfusion of extremities for recurrent tumor in elderly patients.Surgery 1998;123:335–43.

    PubMed  CAS  Google Scholar 

  21. Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients.J Am Geriatr Soc 2001;49:1080–5.

    Article  PubMed  CAS  Google Scholar 

  22. Daley J, Khuri SF, Henderson W, et al. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study.J Am Coll Surg 1997;185:328–40.

    PubMed  CAS  Google Scholar 

  23. Schwarz RE, Karpeh MS, Brennan MF. Factors predicting hospitalization after operative treatment for gastric carcinoma in patients older than 70 years.J Am Coll Surg 1997;184:9–15.

    PubMed  CAS  Google Scholar 

  24. Stam TC, Swaak AJ, de Vries MR, ten Hagen TL, Eggermont AM. Systemic toxicity and cytokine/acute phase protein levels in patients after isolated limb perfusion with tumor necrosis factor-alpha complicated by high leakage.Ann Surg Oncol 2000:7:268–75.

    Article  PubMed  CAS  Google Scholar 

  25. Klaase JM, Kroon BBR, Van Geel BN, Eggermont AMM, Franklin HR, Hart GA. Patient- and treatment-related factors associated with acute regional toxicity after isolated perfusion for melanoma of the extremities.Am J Surg 1994;167:618–20.

    Article  PubMed  CAS  Google Scholar 

  26. van Geel AN, van Wijk J, Wieberdink J. Functional morbidity after regional isolated perfusion of the limb for melanoma.Cancer 1989;63:1092–6.

    Article  PubMed  Google Scholar 

  27. Klaase JM, Kroon BBR, van Slooten GW, Benckhujsen C. Relation between calculated melphalan peak concentrations and toxicity in regional isolated perfusion for melanoma.Reg Cancer Treat 1992;4:309–12.

    Google Scholar 

  28. Sear JW, Rosewarme F. Anaesthesia for surgeons. In: Morris PJ, Malt RA, eds.Oxford Textbook of Surgery. New York: Oxford University Press, 1994:53–82.

    Google Scholar 

  29. McAleese P, Odling-Smee W. The effect of complications on length of stay.Ann Surg 1994;220:740–4.

    Article  PubMed  CAS  Google Scholar 

  30. Klaase JM, Kroon BBR, van Geel AN, et al. Limb recurrence-free interval and survival in patients with recurrent melanoma of the extremities treated with normothermic isolated perfusion.J Am Coll Surg 1994;178:564–72.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University Hospital Rotterdam/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands

    A. N. van Geel MD, PhD & A. M. M. Eggermont MD, PhD

  2. Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    E. M. Noorda MD, B. C. Vrouenraets MD, PhD, O. E. Nieweg MD, PhD & B. B. R. Kroon MD, PhD

Authors
  1. E. M. Noorda MD
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  2. B. C. Vrouenraets MD, PhD
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  3. O. E. Nieweg MD, PhD
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  4. A. N. van Geel MD, PhD
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  5. A. M. M. Eggermont MD, PhD
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  6. B. B. R. Kroon MD, PhD
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Correspondence to E. M. Noorda MD.

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Noorda, E.M., Vrouenraets, B.C., Nieweg, O.E. et al. Safety and efficacy of isolated limb perfusion in elderly melanoma patients. Annals of Surgical Oncology 9, 968–974 (2002). https://doi.org/10.1007/BF02574514

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  • DOI: https://doi.org/10.1007/BF02574514

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