A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities

Christy Y. Chai, Jeremiah L. Deneve, Georgia M. Beasley, Suroosh S. Marzban, Y. Ann Chen, Bhupendra Rawal, Stephen R. Grobmyer, Steven N. Hochwald, Douglas Tyler, Jonathan S. Zager

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Abstract

Background. Hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) are well-accepted regional chemotherapy techniques for in-transit melanoma of extremity. The role and efficacy of repeat regional chemotherapy for recurrence and which salvage procedure is better remains debatable. We aimed to compare toxicities and clinical outcomes by procedure types and the sequence. Methods. Data from 44 patients, who underwent repeat HILPs or ILIs from 3 institutions beginning 1997 to 2010, were retrospectively reviewed. Regional toxicity assessed by Wieberdink grade, systemic toxicity assessed by serum creatine phosphokinase level, length of hospital stay (LOS), response rates at 3 months after the procedure, and time to in-field progression (TTP) were analyzed. Results. Of 44 patients, 46% were men and 54% women with a median age of 66 (range 29-85) years at diagnosis. The median follow-up was 21.4 (range 4-153) months. Of 70 ILIs and 28 HILPs, the following groups were identified: group A, ILI → ILI (n = 25); group B, ILI → HILP (n = 10); group C, HILP → ILI (n = 12); and group D, HILP → HILP (n = 3). The comparison of Wieberdink grade, serum creatine phosphokinase level, LOS, and response rate between procedures (HILP vs. ILI), between sequence (initial vs. repeat), and among their interactions showed no statistically significant differences. TTP after initial procedure did not differ between HILP and ILI (P = 0.08), and no survival difference was seen (P = 0.65) when TTP after repeat procedure was compared. Conclusions. Most patients tolerated repeat regional chemotherapy without increased toxicity or LOS. No statistical difference in clinical outcomes was noted when comparing repeat procedures, even though repeat HILPs showed higher complete response compared to repeat ILIs.

Original languageEnglish (US)
Pages (from-to)1637-1643
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

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Melanoma
Extremities
Drug Therapy
Perfusion
Length of Stay
Creatine Kinase
Serum
Recurrence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Chai, C. Y., Deneve, J. L., Beasley, G. M., Marzban, S. S., Chen, Y. A., Rawal, B., ... Zager, J. S. (2012). A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities. Annals of Surgical Oncology, 19(5), 1637-1643. https://doi.org/10.1245/s10434-011-2151-z

A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities. / Chai, Christy Y.; Deneve, Jeremiah L.; Beasley, Georgia M.; Marzban, Suroosh S.; Chen, Y. Ann; Rawal, Bhupendra; Grobmyer, Stephen R.; Hochwald, Steven N.; Tyler, Douglas; Zager, Jonathan S.

In: Annals of Surgical Oncology, Vol. 19, No. 5, 05.2012, p. 1637-1643.

Research output: Contribution to journalArticle

Chai, CY, Deneve, JL, Beasley, GM, Marzban, SS, Chen, YA, Rawal, B, Grobmyer, SR, Hochwald, SN, Tyler, D & Zager, JS 2012, 'A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities', Annals of Surgical Oncology, vol. 19, no. 5, pp. 1637-1643. https://doi.org/10.1245/s10434-011-2151-z
Chai, Christy Y. ; Deneve, Jeremiah L. ; Beasley, Georgia M. ; Marzban, Suroosh S. ; Chen, Y. Ann ; Rawal, Bhupendra ; Grobmyer, Stephen R. ; Hochwald, Steven N. ; Tyler, Douglas ; Zager, Jonathan S. / A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 5. pp. 1637-1643.
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abstract = "Background. Hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) are well-accepted regional chemotherapy techniques for in-transit melanoma of extremity. The role and efficacy of repeat regional chemotherapy for recurrence and which salvage procedure is better remains debatable. We aimed to compare toxicities and clinical outcomes by procedure types and the sequence. Methods. Data from 44 patients, who underwent repeat HILPs or ILIs from 3 institutions beginning 1997 to 2010, were retrospectively reviewed. Regional toxicity assessed by Wieberdink grade, systemic toxicity assessed by serum creatine phosphokinase level, length of hospital stay (LOS), response rates at 3 months after the procedure, and time to in-field progression (TTP) were analyzed. Results. Of 44 patients, 46{\%} were men and 54{\%} women with a median age of 66 (range 29-85) years at diagnosis. The median follow-up was 21.4 (range 4-153) months. Of 70 ILIs and 28 HILPs, the following groups were identified: group A, ILI → ILI (n = 25); group B, ILI → HILP (n = 10); group C, HILP → ILI (n = 12); and group D, HILP → HILP (n = 3). The comparison of Wieberdink grade, serum creatine phosphokinase level, LOS, and response rate between procedures (HILP vs. ILI), between sequence (initial vs. repeat), and among their interactions showed no statistically significant differences. TTP after initial procedure did not differ between HILP and ILI (P = 0.08), and no survival difference was seen (P = 0.65) when TTP after repeat procedure was compared. Conclusions. Most patients tolerated repeat regional chemotherapy without increased toxicity or LOS. No statistical difference in clinical outcomes was noted when comparing repeat procedures, even though repeat HILPs showed higher complete response compared to repeat ILIs.",
author = "Chai, {Christy Y.} and Deneve, {Jeremiah L.} and Beasley, {Georgia M.} and Marzban, {Suroosh S.} and Chen, {Y. Ann} and Bhupendra Rawal and Grobmyer, {Stephen R.} and Hochwald, {Steven N.} and Douglas Tyler and Zager, {Jonathan S.}",
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T1 - A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of extremities

AU - Chai, Christy Y.

AU - Deneve, Jeremiah L.

AU - Beasley, Georgia M.

AU - Marzban, Suroosh S.

AU - Chen, Y. Ann

AU - Rawal, Bhupendra

AU - Grobmyer, Stephen R.

AU - Hochwald, Steven N.

AU - Tyler, Douglas

AU - Zager, Jonathan S.

PY - 2012/5

Y1 - 2012/5

N2 - Background. Hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) are well-accepted regional chemotherapy techniques for in-transit melanoma of extremity. The role and efficacy of repeat regional chemotherapy for recurrence and which salvage procedure is better remains debatable. We aimed to compare toxicities and clinical outcomes by procedure types and the sequence. Methods. Data from 44 patients, who underwent repeat HILPs or ILIs from 3 institutions beginning 1997 to 2010, were retrospectively reviewed. Regional toxicity assessed by Wieberdink grade, systemic toxicity assessed by serum creatine phosphokinase level, length of hospital stay (LOS), response rates at 3 months after the procedure, and time to in-field progression (TTP) were analyzed. Results. Of 44 patients, 46% were men and 54% women with a median age of 66 (range 29-85) years at diagnosis. The median follow-up was 21.4 (range 4-153) months. Of 70 ILIs and 28 HILPs, the following groups were identified: group A, ILI → ILI (n = 25); group B, ILI → HILP (n = 10); group C, HILP → ILI (n = 12); and group D, HILP → HILP (n = 3). The comparison of Wieberdink grade, serum creatine phosphokinase level, LOS, and response rate between procedures (HILP vs. ILI), between sequence (initial vs. repeat), and among their interactions showed no statistically significant differences. TTP after initial procedure did not differ between HILP and ILI (P = 0.08), and no survival difference was seen (P = 0.65) when TTP after repeat procedure was compared. Conclusions. Most patients tolerated repeat regional chemotherapy without increased toxicity or LOS. No statistical difference in clinical outcomes was noted when comparing repeat procedures, even though repeat HILPs showed higher complete response compared to repeat ILIs.

AB - Background. Hyperthermic isolated limb perfusion (HILP) or isolated limb infusion (ILI) are well-accepted regional chemotherapy techniques for in-transit melanoma of extremity. The role and efficacy of repeat regional chemotherapy for recurrence and which salvage procedure is better remains debatable. We aimed to compare toxicities and clinical outcomes by procedure types and the sequence. Methods. Data from 44 patients, who underwent repeat HILPs or ILIs from 3 institutions beginning 1997 to 2010, were retrospectively reviewed. Regional toxicity assessed by Wieberdink grade, systemic toxicity assessed by serum creatine phosphokinase level, length of hospital stay (LOS), response rates at 3 months after the procedure, and time to in-field progression (TTP) were analyzed. Results. Of 44 patients, 46% were men and 54% women with a median age of 66 (range 29-85) years at diagnosis. The median follow-up was 21.4 (range 4-153) months. Of 70 ILIs and 28 HILPs, the following groups were identified: group A, ILI → ILI (n = 25); group B, ILI → HILP (n = 10); group C, HILP → ILI (n = 12); and group D, HILP → HILP (n = 3). The comparison of Wieberdink grade, serum creatine phosphokinase level, LOS, and response rate between procedures (HILP vs. ILI), between sequence (initial vs. repeat), and among their interactions showed no statistically significant differences. TTP after initial procedure did not differ between HILP and ILI (P = 0.08), and no survival difference was seen (P = 0.65) when TTP after repeat procedure was compared. Conclusions. Most patients tolerated repeat regional chemotherapy without increased toxicity or LOS. No statistical difference in clinical outcomes was noted when comparing repeat procedures, even though repeat HILPs showed higher complete response compared to repeat ILIs.

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