Current trends in regional therapy for melanoma

Lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution

Amanda K. Raymond, Georgia M. Beasley, Gloria Broadwater, Christina K. Augustine, James C. Padussis, Ryan Turley, Bercedis Peterson, Hilliard Seigler, Scott K. Pruitt, Douglas Tyler

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Background: Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are used to manage advanced extremity melanoma, but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. Study Design: Using a prospectively maintained database, we reviewed our experience with melphalan-based HILP (which included 62 first-time and 10 second-time) and ILI (which included 126 first-time and 18 second-time) procedures performed in 188 patients. PET/CT was obtained 3 months postregional treatment for 1 year and then every 6 months thereafter. Results: Overall response rate (complete response [CR] + partial response) of HILP was 81% (80% CI, 73-87%), and overall response rate from ILI was 43% (80% CI, 37-49%) for first-time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, and ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR after repeat HILP (50%, n = 10) compared with repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2 of 62) than ILI (0 of 122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25 of 49; 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%. Conclusions: In the largest single-institution regional therapy series reported to date, we found that although ILI is effective and well-tolerated, HILP is a more definitive way to control advanced disease.

Original languageEnglish (US)
Pages (from-to)306-316
Number of pages11
JournalJournal of the American College of Surgeons
Volume213
Issue number2
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Melanoma
Extremities
Drug Therapy
Perfusion
Therapeutics
Melphalan
Lung Diseases

Keywords

  • Common Terminology Criteria for Adverse Events
  • complete response
  • CPK
  • CR
  • creatine phosphokinase
  • CTCAE
  • HILP
  • hyperthermic isolated limb perfusion
  • IBW
  • ideal body weight
  • ILI
  • isolated limb perfusion
  • NE
  • not evaluable
  • partial response
  • PD
  • PR
  • progressive disease
  • SD
  • stable disease
  • time to in-field progression
  • TTiP

ASJC Scopus subject areas

  • Surgery

Cite this

Current trends in regional therapy for melanoma : Lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution. / Raymond, Amanda K.; Beasley, Georgia M.; Broadwater, Gloria; Augustine, Christina K.; Padussis, James C.; Turley, Ryan; Peterson, Bercedis; Seigler, Hilliard; Pruitt, Scott K.; Tyler, Douglas.

In: Journal of the American College of Surgeons, Vol. 213, No. 2, 08.2011, p. 306-316.

Research output: Contribution to journalArticle

Raymond, Amanda K. ; Beasley, Georgia M. ; Broadwater, Gloria ; Augustine, Christina K. ; Padussis, James C. ; Turley, Ryan ; Peterson, Bercedis ; Seigler, Hilliard ; Pruitt, Scott K. ; Tyler, Douglas. / Current trends in regional therapy for melanoma : Lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution. In: Journal of the American College of Surgeons. 2011 ; Vol. 213, No. 2. pp. 306-316.
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abstract = "Background: Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are used to manage advanced extremity melanoma, but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. Study Design: Using a prospectively maintained database, we reviewed our experience with melphalan-based HILP (which included 62 first-time and 10 second-time) and ILI (which included 126 first-time and 18 second-time) procedures performed in 188 patients. PET/CT was obtained 3 months postregional treatment for 1 year and then every 6 months thereafter. Results: Overall response rate (complete response [CR] + partial response) of HILP was 81{\%} (80{\%} CI, 73-87{\%}), and overall response rate from ILI was 43{\%} (80{\%} CI, 37-49{\%}) for first-time procedures only. HILP had a CR rate of 55{\%} with a median duration of 32 months, and ILI had a CR rate of 30{\%} with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR after repeat HILP (50{\%}, n = 10) compared with repeat ILI (28{\%}, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2 of 62) than ILI (0 of 122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25 of 49; 51{\%} of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50{\%}. Conclusions: In the largest single-institution regional therapy series reported to date, we found that although ILI is effective and well-tolerated, HILP is a more definitive way to control advanced disease.",
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AU - Augustine, Christina K.

AU - Padussis, James C.

AU - Turley, Ryan

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N2 - Background: Hyperthermic isolated limb perfusion (HILP) and isolated limb infusion (ILI) are used to manage advanced extremity melanoma, but no consensus exists as to which treatment is preferable and how to monitor patients post-treatment. Study Design: Using a prospectively maintained database, we reviewed our experience with melphalan-based HILP (which included 62 first-time and 10 second-time) and ILI (which included 126 first-time and 18 second-time) procedures performed in 188 patients. PET/CT was obtained 3 months postregional treatment for 1 year and then every 6 months thereafter. Results: Overall response rate (complete response [CR] + partial response) of HILP was 81% (80% CI, 73-87%), and overall response rate from ILI was 43% (80% CI, 37-49%) for first-time procedures only. HILP had a CR rate of 55% with a median duration of 32 months, and ILI had a CR rate of 30% with median duration of 24 months. Patients who experienced a regional recurrence after initial regional treatment were more likely to achieve a CR after repeat HILP (50%, n = 10) compared with repeat ILI (28%, n = 18). Although the spectrum of toxicity was similar for ILI and HILP, the likelihood of rare catastrophic complication of limb loss was greater with HILP (2 of 62) than ILI (0 of 122). PET/CT was effective for surveillance after regional therapy to identify regional nodal and pulmonary disease that was not clinically evident, but often amenable to surgical resection (25 of 49; 51% of cases). In contrast, PET/CT was not effective at predicting complete response to treatment with an accuracy of only 50%. Conclusions: In the largest single-institution regional therapy series reported to date, we found that although ILI is effective and well-tolerated, HILP is a more definitive way to control advanced disease.

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