Isolated limb infusion for in-transit malignant melanoma of the extremity

A well-tolerated but less effective alternative to hyperthermic isolated limb perfusion

Georgia M. Beasley, Rebecca P. Petersen, Jin Yoo, Nicole McMahon, Thomas Aloia, William Petros, Gretchen Sanders, Tsung Yen Cheng, Scott K. Pruitt, Hilliard Seigler, Douglas Tyler

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Background: Isolated limb infusion (ILI) is a recently described minimally invasive technique developed in Australia for delivering regional chemotherapy. This study examined the efficacy and toxicity of ILI, compared to hyperthermic isolated limb perfusion (HILP), in treating extremity in-transit melanoma. Methods: Variables from a prospective single institution database of 120 regionally treated melanoma patients (1995-2007) were compared using chi-square analysis. This included 61 consecutive ILI treatments in 58 patients and 59 HILP treatments in 54 patients. Response was defined at 3 months using the response evaluation criteria in solid tumors (RECIST). ILI was performed using melphalan (LPAM) and dactinomycin for 30 min after limb temperature reached 37°C. HILP was performed using LPAM for 60 min after limb temperature reached 38.5°C. Results: For ILI (n = 61), the complete response (CR) rate was 30%, the partial response (PR) rate was 14%, and there was no response (NR) in 56% of patients. The median duration of CR was 12 months and 18% of patients experienced (grade ≥3) toxicity. HILP (n = 59) was associated with a better (P < 0.001) response rate (CR 57%, PR 31%, and NR 12%) however, more patients (32%) experienced grade ≥3 toxicity (P = 0.037). The dose of LPAM was corrected for ideal body weight (IBW) in 40 out of 61 ILI procedures, and 13 of 59 HILP procedures. This dosing modification was associated with decreased toxicity (P = 0.024) without diminishing response. Conclusion: ILI was found to be a well-tolerated alternative to HILP. While ILI does not appear to be as effective as HILP, it does seem to be associated with less morbidity.

Original languageEnglish (US)
Pages (from-to)2195-2205
Number of pages11
JournalAnnals of Surgical Oncology
Volume15
Issue number8
DOIs
StatePublished - Aug 2008
Externally publishedYes

Fingerprint

Melanoma
Extremities
Perfusion
Ideal Body Weight
Temperature
Melphalan
Dactinomycin

Keywords

  • Isolated limb infusion
  • Melanoma
  • Regional chemotherapy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Isolated limb infusion for in-transit malignant melanoma of the extremity : A well-tolerated but less effective alternative to hyperthermic isolated limb perfusion. / Beasley, Georgia M.; Petersen, Rebecca P.; Yoo, Jin; McMahon, Nicole; Aloia, Thomas; Petros, William; Sanders, Gretchen; Cheng, Tsung Yen; Pruitt, Scott K.; Seigler, Hilliard; Tyler, Douglas.

In: Annals of Surgical Oncology, Vol. 15, No. 8, 08.2008, p. 2195-2205.

Research output: Contribution to journalArticle

Beasley, Georgia M. ; Petersen, Rebecca P. ; Yoo, Jin ; McMahon, Nicole ; Aloia, Thomas ; Petros, William ; Sanders, Gretchen ; Cheng, Tsung Yen ; Pruitt, Scott K. ; Seigler, Hilliard ; Tyler, Douglas. / Isolated limb infusion for in-transit malignant melanoma of the extremity : A well-tolerated but less effective alternative to hyperthermic isolated limb perfusion. In: Annals of Surgical Oncology. 2008 ; Vol. 15, No. 8. pp. 2195-2205.
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abstract = "Background: Isolated limb infusion (ILI) is a recently described minimally invasive technique developed in Australia for delivering regional chemotherapy. This study examined the efficacy and toxicity of ILI, compared to hyperthermic isolated limb perfusion (HILP), in treating extremity in-transit melanoma. Methods: Variables from a prospective single institution database of 120 regionally treated melanoma patients (1995-2007) were compared using chi-square analysis. This included 61 consecutive ILI treatments in 58 patients and 59 HILP treatments in 54 patients. Response was defined at 3 months using the response evaluation criteria in solid tumors (RECIST). ILI was performed using melphalan (LPAM) and dactinomycin for 30 min after limb temperature reached 37°C. HILP was performed using LPAM for 60 min after limb temperature reached 38.5°C. Results: For ILI (n = 61), the complete response (CR) rate was 30{\%}, the partial response (PR) rate was 14{\%}, and there was no response (NR) in 56{\%} of patients. The median duration of CR was 12 months and 18{\%} of patients experienced (grade ≥3) toxicity. HILP (n = 59) was associated with a better (P < 0.001) response rate (CR 57{\%}, PR 31{\%}, and NR 12{\%}) however, more patients (32{\%}) experienced grade ≥3 toxicity (P = 0.037). The dose of LPAM was corrected for ideal body weight (IBW) in 40 out of 61 ILI procedures, and 13 of 59 HILP procedures. This dosing modification was associated with decreased toxicity (P = 0.024) without diminishing response. Conclusion: ILI was found to be a well-tolerated alternative to HILP. While ILI does not appear to be as effective as HILP, it does seem to be associated with less morbidity.",
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T1 - Isolated limb infusion for in-transit malignant melanoma of the extremity

T2 - A well-tolerated but less effective alternative to hyperthermic isolated limb perfusion

AU - Beasley, Georgia M.

AU - Petersen, Rebecca P.

AU - Yoo, Jin

AU - McMahon, Nicole

AU - Aloia, Thomas

AU - Petros, William

AU - Sanders, Gretchen

AU - Cheng, Tsung Yen

AU - Pruitt, Scott K.

AU - Seigler, Hilliard

AU - Tyler, Douglas

PY - 2008/8

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N2 - Background: Isolated limb infusion (ILI) is a recently described minimally invasive technique developed in Australia for delivering regional chemotherapy. This study examined the efficacy and toxicity of ILI, compared to hyperthermic isolated limb perfusion (HILP), in treating extremity in-transit melanoma. Methods: Variables from a prospective single institution database of 120 regionally treated melanoma patients (1995-2007) were compared using chi-square analysis. This included 61 consecutive ILI treatments in 58 patients and 59 HILP treatments in 54 patients. Response was defined at 3 months using the response evaluation criteria in solid tumors (RECIST). ILI was performed using melphalan (LPAM) and dactinomycin for 30 min after limb temperature reached 37°C. HILP was performed using LPAM for 60 min after limb temperature reached 38.5°C. Results: For ILI (n = 61), the complete response (CR) rate was 30%, the partial response (PR) rate was 14%, and there was no response (NR) in 56% of patients. The median duration of CR was 12 months and 18% of patients experienced (grade ≥3) toxicity. HILP (n = 59) was associated with a better (P < 0.001) response rate (CR 57%, PR 31%, and NR 12%) however, more patients (32%) experienced grade ≥3 toxicity (P = 0.037). The dose of LPAM was corrected for ideal body weight (IBW) in 40 out of 61 ILI procedures, and 13 of 59 HILP procedures. This dosing modification was associated with decreased toxicity (P = 0.024) without diminishing response. Conclusion: ILI was found to be a well-tolerated alternative to HILP. While ILI does not appear to be as effective as HILP, it does seem to be associated with less morbidity.

AB - Background: Isolated limb infusion (ILI) is a recently described minimally invasive technique developed in Australia for delivering regional chemotherapy. This study examined the efficacy and toxicity of ILI, compared to hyperthermic isolated limb perfusion (HILP), in treating extremity in-transit melanoma. Methods: Variables from a prospective single institution database of 120 regionally treated melanoma patients (1995-2007) were compared using chi-square analysis. This included 61 consecutive ILI treatments in 58 patients and 59 HILP treatments in 54 patients. Response was defined at 3 months using the response evaluation criteria in solid tumors (RECIST). ILI was performed using melphalan (LPAM) and dactinomycin for 30 min after limb temperature reached 37°C. HILP was performed using LPAM for 60 min after limb temperature reached 38.5°C. Results: For ILI (n = 61), the complete response (CR) rate was 30%, the partial response (PR) rate was 14%, and there was no response (NR) in 56% of patients. The median duration of CR was 12 months and 18% of patients experienced (grade ≥3) toxicity. HILP (n = 59) was associated with a better (P < 0.001) response rate (CR 57%, PR 31%, and NR 12%) however, more patients (32%) experienced grade ≥3 toxicity (P = 0.037). The dose of LPAM was corrected for ideal body weight (IBW) in 40 out of 61 ILI procedures, and 13 of 59 HILP procedures. This dosing modification was associated with decreased toxicity (P = 0.024) without diminishing response. Conclusion: ILI was found to be a well-tolerated alternative to HILP. While ILI does not appear to be as effective as HILP, it does seem to be associated with less morbidity.

KW - Isolated limb infusion

KW - Melanoma

KW - Regional chemotherapy

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