Isolated Limb Infusion For Melanoma Research Articles

ASO Author Reflections: Return to Isolated Limb Infusion for In-Transit Melanoma.

O’Donoghue C, Perez MC, Mullinax JE, et al. Isolated limb infusion: a single-center experience with over 200 infusions. Ann Surg Oncol. 2017;24:3842–9. https://doi.org/10.1245/s10434-017-6107-9. Article PubMed Google Scholar Kroon HM, Moncrieff M, Kam PC, Thompson JF. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008;15:3003–13. https://doi.org/10.1245/s10434-008-9954-6. Article PubMed Google Scholar Miura JT, Kroon HM, Beasley GM, et al. Long–term oncologic outcomes after isolated limb infusion for locoregionally metastatic melanoma: an international multicenter analysis. Ann Surg Oncol. 2019;26:2486–94. https://doi.org/10.1245/s10434-019-07288-w. Article PubMed Google Scholar Carr MJ, Sun J, Kroon HM, et al. Oncologic outcomes after isolated limb infusion for advanced melanoma: an international comparison of the procedure and outcomes between the United States and Australia. Ann Surg Oncol. https://doi.org/10.1245/s10434-020-09051-y. Muilenburg, DJ, Beasley, GM, Thompson, ZJ, et al. Burden of disease predicts response to isolated limb infusion with melphalan and actinomycin D in melanoma. Ann Surg Oncol. 2015;22:482–8. https://doi.org/10.1245/s10434-014-4072-0. Article PubMed Google Scholar Download references Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA Michael J. Carr MD, MS & Jonathan S. Zager MD Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia Hidde M. Kroon MD, PhD Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia Hidde M. Kroon MD, PhD Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA Jonathan S. Zager MD You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar You can also search for this author in PubMed Google Scholar Correspondence to Jonathan S. Zager MD. Jonathan S. Zager has had a US patent issued (US Patent # 10,583,246) on high-flow ILI. Michael J. Carr and Hidde M. Kroon have no financial or material disclosures to report regarding the subject matter of this study and the discussion within this manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Below is the link to the electronic supplementary material. Reprints and Permissions Carr, M.J., Kroon, H.M. & Zager, J.S. ASO Author Reflections: Return to Isolated Limb Infusion for In-Transit Melanoma. Ann Surg Oncol (2020). https://doi.org/10.1245/s10434-020-09113-1 Download citation Received: 26 August 2020 Accepted: 26 August 2020 Published: 11 September 2020 DOI: https://doi.org/10.1245/s10434-020-09113-1

ASO Author Reflections: International Experience of Isolated Limb Infusion for Melanoma Shows Durable Response.

ASO Author Reflections: International Experience of Isolated Limb Infusion for Melanoma Shows Durable Response.

Isolated Limb Infusion For Melanoma and Sarcoma Performed in the Endovascular Operating Room

Isolated Limb Infusion For Melanoma and Sarcoma Performed in the Endovascular Operating Room

Is Melphalan Dose Adjustment According to Ideal Body Weight Useful in Isolated Limb Infusion for Melanoma?

Isolated limb infusion (ILI), introduced in 1992, is a technique used to deliver regional chemotherapy to treat advanced melanoma confined to a limb. Adjusting melphalan dose according to ideal body weight (IBW) has been proposed as a method of decreasing limb toxicity without compromising outcome. The current study analyzed this proposed dose adjustment. We reviewed 99 consecutive patients with lower extremity melanomas treated by ILI at our institution between May 1998 and February 2009. Toxicity and outcomes were tested for correlation with differences between administered dose and calculated adjusted dose, both in mg and mg/L, and with differences between actual limb volume and calculated adjusted limb volume. The median actual body weight was 71 kg, whereas the calculated median IBW was 57 kg (p < .001). Median administered melphalan dose was 7.7 mg/L. The median calculated adjusted dose was 6.5 mg/L (range 3.2-9.3 mg/L, p < .001). None of the three aforementioned parameters correlated with either Wieberdink toxicity grade or outcome. BMI did not correlate with toxicity either. Interestingly, a higher total melphalan dose did not only correlate with higher toxicity, but also with a lower response rate. Adjusting the melphalan dose for IBW does not appear to reduce toxicity following ILI for melanoma. The effect on outcome remains uncertain. More research is needed to optimize melphalan concentrations in individual patients during ILI to limit toxicity without compromising the response.

Quality of Life Outcomes after Isolated Limb Infusion

Isolated limb infusion (ILI) for the treatment of in-transit melanoma was originally described more than 10 years ago. Response rates of 45-53% have been reported in U.S. series. Long-term quality of life outcomes after this procedure have not been described. We hypothesized that ILI is rarely associated with long-term limb morbidity. ILIs performed at our institution between July 2005 and June 2009 were reviewed. Patients were contacted cross-sectionally at 2 time points. During these interviews, response to treatment and postoperative limb function were assessed. Thirty-two ILIs were performed during the time period. Twenty-seven patients were treated for in-transit melanoma; 5 were treated for recurrent Merkel cell carcinoma. The 30-day mortality was 0%. Three patients (9%) required fasciotomy. Durable complete responses were achieved in 41% of patients, with mean follow-up time of 19.4 ± 9.6 months after infusion; after this period, 53% reported progression of disease. The most common postprocedure symptoms were edema (88%), numbness (59%), and pain (59%). By 3 months and at the time of last follow-up, the most common symptoms were edema (82%), numbness (65%), and stiffness (35%). No patients reported impaired limb function at the time of last follow-up compared to baseline. Median survival was 19.2 ± 4.2 months after infusion. ILI for melanoma and Merkel cell carcinoma is associated with postprocedure symptoms in most patients, most commonly edema, color change, and numbness. At last follow-up, no ILI patients had residual functional impairment in the treated limb.

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

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. 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). 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 CO(2 )level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema). 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.