A Multi-Institutional Experience of Isolated Limb Infusion: Defining Response and Toxicity in the US

Georgia M. Beasley, Abigail Caudle, Rebecca P. Petersen, Nicole S. McMahon, James Padussis, Paul J. Mosca, Jonathan S. Zager, Steven N. Hochwald, Stephen R. Grobmyer, Keith A. Delman, Robert H. Andtbacka, R. Dirk Noyes, John M. Kane, Hilliard Seigler, Scott K. Pruitt, Merrick I. Ross, Douglas Tyler

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Background: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. Study Design: Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42% (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. Results: In 128 evaluable patients, complete response rate was 31%, partial response rate was 33%, and there was no response in 36% of patients. For all patients (n = 162), 36% had Wieberdink toxicity grade ≥3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade ≥3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). Conclusions: In the first multi-institutional analysis of ILI, a complete response rate of 31% was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.

Original languageEnglish (US)
Pages (from-to)706-715
Number of pages10
JournalJournal of the American College of Surgeons
Volume208
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

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Extremities
Melanoma
Ideal Body Weight
Melphalan
Perfusion
Papaverine
Amputation
Vasodilation
Multivariate Analysis
Students
Skin

ASJC Scopus subject areas

  • Surgery

Cite this

A Multi-Institutional Experience of Isolated Limb Infusion : Defining Response and Toxicity in the US. / Beasley, Georgia M.; Caudle, Abigail; Petersen, Rebecca P.; McMahon, Nicole S.; Padussis, James; Mosca, Paul J.; Zager, Jonathan S.; Hochwald, Steven N.; Grobmyer, Stephen R.; Delman, Keith A.; Andtbacka, Robert H.; Noyes, R. Dirk; Kane, John M.; Seigler, Hilliard; Pruitt, Scott K.; Ross, Merrick I.; Tyler, Douglas.

In: Journal of the American College of Surgeons, Vol. 208, No. 5, 05.2009, p. 706-715.

Research output: Contribution to journalArticle

Beasley, GM, Caudle, A, Petersen, RP, McMahon, NS, Padussis, J, Mosca, PJ, Zager, JS, Hochwald, SN, Grobmyer, SR, Delman, KA, Andtbacka, RH, Noyes, RD, Kane, JM, Seigler, H, Pruitt, SK, Ross, MI & Tyler, D 2009, 'A Multi-Institutional Experience of Isolated Limb Infusion: Defining Response and Toxicity in the US', Journal of the American College of Surgeons, vol. 208, no. 5, pp. 706-715. https://doi.org/10.1016/j.jamcollsurg.2008.12.019
Beasley, Georgia M. ; Caudle, Abigail ; Petersen, Rebecca P. ; McMahon, Nicole S. ; Padussis, James ; Mosca, Paul J. ; Zager, Jonathan S. ; Hochwald, Steven N. ; Grobmyer, Stephen R. ; Delman, Keith A. ; Andtbacka, Robert H. ; Noyes, R. Dirk ; Kane, John M. ; Seigler, Hilliard ; Pruitt, Scott K. ; Ross, Merrick I. ; Tyler, Douglas. / A Multi-Institutional Experience of Isolated Limb Infusion : Defining Response and Toxicity in the US. In: Journal of the American College of Surgeons. 2009 ; Vol. 208, No. 5. pp. 706-715.
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abstract = "Background: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. Study Design: Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42{\%} (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. Results: In 128 evaluable patients, complete response rate was 31{\%}, partial response rate was 33{\%}, and there was no response in 36{\%} of patients. For all patients (n = 162), 36{\%} had Wieberdink toxicity grade ≥3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade ≥3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). Conclusions: In the first multi-institutional analysis of ILI, a complete response rate of 31{\%} was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.",
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T1 - A Multi-Institutional Experience of Isolated Limb Infusion

T2 - Defining Response and Toxicity in the US

AU - Beasley, Georgia M.

AU - Caudle, Abigail

AU - Petersen, Rebecca P.

AU - McMahon, Nicole S.

AU - Padussis, James

AU - Mosca, Paul J.

AU - Zager, Jonathan S.

AU - Hochwald, Steven N.

AU - Grobmyer, Stephen R.

AU - Delman, Keith A.

AU - Andtbacka, Robert H.

AU - Noyes, R. Dirk

AU - Kane, John M.

AU - Seigler, Hilliard

AU - Pruitt, Scott K.

AU - Ross, Merrick I.

AU - Tyler, Douglas

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N2 - Background: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. Study Design: Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42% (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. Results: In 128 evaluable patients, complete response rate was 31%, partial response rate was 33%, and there was no response in 36% of patients. For all patients (n = 162), 36% had Wieberdink toxicity grade ≥3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade ≥3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). Conclusions: In the first multi-institutional analysis of ILI, a complete response rate of 31% was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.

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