TY - JOUR
T1 - Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma
AU - Sharma, Ketan
AU - Beasley, Georgia
AU - Turley, Ryan
AU - Raymond, Amanda K.
AU - Broadwater, Gloria
AU - Peterson, Bercedis
AU - Mosca, Paul
AU - Tyler, Douglas
N1 - Funding Information:
ACKNOWLEDGMENT Dr. Tyler received honorarium as conference attendee from Adherex Technologies, Inc., and the ADH-1 trial was supported by a grant from Adherex Technologies, Inc. Bayer Healthcare Pharmaceuticals provided study drug (sorafenib, Nexavar) for the phase I trial of systemic sorafenib and regional melphalan, and Dr. Tyler received honorarium from Bayer Healthcare Pharmaceuticals for participation in an Investigator’s Conference. All data analysis concerning this manuscript was performed at Duke.
PY - 2012/8
Y1 - 2012/8
N2 - Background: Even after complete response (CR) to regional chemotherapy for in-transit melanoma, many patients develop recurrence. Understanding the probability, location, and timing of recurrences can optimize management strategies for this patient population. Methods: A prospective database identified patients who underwent 81 first-time hyperthermic isolated limb perfusions (HILPs) and 133 first-time isolated limb infusions (ILIs). Response was defined using the response evaluation criteria in solid tumors; recurrence was defined as development of new disease after in-field CR. Results: HILP exhibited a significantly higher CR rate than ILI (44 vs. 28 %, p = .01). Among 36 HILP-CRs and 37 ILI-CRs, the 3-year recurrence rate was 65 % (95 % confidence interval [95 % CI]: 43-79 %) and 85 % (95 % CI: 63-94%), respectively. Median time to first recurrence was longer for HILP-CR than ILI-CR (23 vs. 8 months, p = .02). There was no statistically significant difference in median time to in-field recurrence between HILP-CR and ILI-CR (46 vs. 25 months, p = .15), but HILP-CR showed a longer median time to out-of-field recurrence (42 vs. 14 months, p = .02). Finally, the overall survival (OS) difference between HILP-CR and ILI-CR (3-year survival: 77 vs. 54 %) did not achieve statistical significance (p = .10). Conclusions: In the largest series comparing patterns of recurrence, we demonstrate that out-of-field recurrence after CR to HILP occurs later than after CR to ILI, though control of in-field disease remains similar. There remains no statistically significant difference in overall survival after CR to the 2 procedures.
AB - Background: Even after complete response (CR) to regional chemotherapy for in-transit melanoma, many patients develop recurrence. Understanding the probability, location, and timing of recurrences can optimize management strategies for this patient population. Methods: A prospective database identified patients who underwent 81 first-time hyperthermic isolated limb perfusions (HILPs) and 133 first-time isolated limb infusions (ILIs). Response was defined using the response evaluation criteria in solid tumors; recurrence was defined as development of new disease after in-field CR. Results: HILP exhibited a significantly higher CR rate than ILI (44 vs. 28 %, p = .01). Among 36 HILP-CRs and 37 ILI-CRs, the 3-year recurrence rate was 65 % (95 % confidence interval [95 % CI]: 43-79 %) and 85 % (95 % CI: 63-94%), respectively. Median time to first recurrence was longer for HILP-CR than ILI-CR (23 vs. 8 months, p = .02). There was no statistically significant difference in median time to in-field recurrence between HILP-CR and ILI-CR (46 vs. 25 months, p = .15), but HILP-CR showed a longer median time to out-of-field recurrence (42 vs. 14 months, p = .02). Finally, the overall survival (OS) difference between HILP-CR and ILI-CR (3-year survival: 77 vs. 54 %) did not achieve statistical significance (p = .10). Conclusions: In the largest series comparing patterns of recurrence, we demonstrate that out-of-field recurrence after CR to HILP occurs later than after CR to ILI, though control of in-field disease remains similar. There remains no statistically significant difference in overall survival after CR to the 2 procedures.
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U2 - 10.1245/s10434-012-2315-5
DO - 10.1245/s10434-012-2315-5
M3 - Article
C2 - 22476748
AN - SCOPUS:84865031036
SN - 1068-9265
VL - 19
SP - 2563
EP - 2571
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 8
ER -