Journal
ANNALS OF SURGICAL ONCOLOGY
Volume 15, Issue 11, Pages 3003-3013Publisher
SPRINGER
DOI: 10.1245/s10434-008-9954-6
Keywords
Isolated limb infusion; Hypoxia; Metastatic melanoma; Melphalan; Actinomycin-D; Regional chemotherapy
Funding
- Haak Bastiaanse-Kuneman Stichting
- Stichting Fundatie van de Vrijvrouwe van Renswoude te 's-Gravenhage
- Stichting Noordelijk Chirurgisch Oncologisch Fonds
- Stichting Sacha Swarttouw-Heijmans
- KWF Kank-erbestrijding
- Stichting Prof. Michael-van Vloten Fonds
- Amgen Netherlands BV
- University of Groningen
- Melanoma Foundation of the University of Sydney
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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 degrees C). Result: 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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