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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2008

01-11-2008 | Melanomas

Outcomes Following Isolated Limb Infusion for Melanoma. A 14-Year Experience

Authors: Hidde M. Kroon, MD, Marc Moncrieff, MD, Peter C. A. Kam, MD, John F. Thompson, MD

Published in: Annals of Surgical Oncology | Issue 11/2008

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Abstract

Background

Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation.

Methods

From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20–30 min under mild hyperthermic conditions (38–39°C).

Results

The majority of patients (62%) were female. Their average age was 74 years (range 29–93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable outcome were achievement of CR, stage of disease, thickness of primary melanoma, the CO2 level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema).

Conclusion

The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.
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Metadata
Title
Outcomes Following Isolated Limb Infusion for Melanoma. A 14-Year Experience
Authors
Hidde M. Kroon, MD
Marc Moncrieff, MD
Peter C. A. Kam, MD
John F. Thompson, MD
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-008-9954-6

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