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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2019

01-08-2019 | Melanoma | Melanoma

Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma: An International Multicenter Analysis

Authors: John T. Miura, MD, Hidde M. Kroon, MD, PhD, Georgia M. Beasley, MD, MHS, Dean Mullen, BA (Hons), Norma E. Farrow, MD, Paul J. Mosca, MD, PhD, MBA, Michael C. Lowe, MD, MA, Clara R. Farley, MD, Youngchul Kim, PhD, Syeda Mahrukh Hussnain Naqvi, MD, MPH, Aishwarya Potdar, BS, Hala Daou, BS, James Sun, MD, Jeffrey M. Farma, MD, FACS, Michael A. Henderson, MBBS, BMedSc, FRACS, David Speakman, MBBS, Jonathan Serpell, MBBS, MEd, FRACS, FACS, FRCSEd, Keith A. Delman, MD, B. Mark Smithers, MBBS, FRACS, FRCS, Brendon J. Coventry, MBBS, PhD, FRACS, FACS, FRSM, Douglas S. Tyler, MD, John F. Thompson, MD, FRACS, FACS, Jonathan S. Zager, MD, FACS

Published in: Annals of Surgical Oncology | Issue 8/2019

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Abstract

Background

Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma.

Methods

Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS).

Results

A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD).

Conclusion

This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.
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Metadata
Title
Long–Term Oncologic Outcomes After Isolated Limb Infusion for Locoregionally Metastatic Melanoma: An International Multicenter Analysis
Authors
John T. Miura, MD
Hidde M. Kroon, MD, PhD
Georgia M. Beasley, MD, MHS
Dean Mullen, BA (Hons)
Norma E. Farrow, MD
Paul J. Mosca, MD, PhD, MBA
Michael C. Lowe, MD, MA
Clara R. Farley, MD
Youngchul Kim, PhD
Syeda Mahrukh Hussnain Naqvi, MD, MPH
Aishwarya Potdar, BS
Hala Daou, BS
James Sun, MD
Jeffrey M. Farma, MD, FACS
Michael A. Henderson, MBBS, BMedSc, FRACS
David Speakman, MBBS
Jonathan Serpell, MBBS, MEd, FRACS, FACS, FRCSEd
Keith A. Delman, MD
B. Mark Smithers, MBBS, FRACS, FRCS
Brendon J. Coventry, MBBS, PhD, FRACS, FACS, FRSM
Douglas S. Tyler, MD
John F. Thompson, MD, FRACS, FACS
Jonathan S. Zager, MD, FACS
Publication date
01-08-2019
Publisher
Springer International Publishing
Keywords
Melanoma
Melanoma
Published in
Annals of Surgical Oncology / Issue 8/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07288-w

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