Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma

Ketan Sharma, Georgia Beasley, Ryan Turley, Amanda K. Raymond, Gloria Broadwater, Bercedis Peterson, Paul Mosca, Douglas Tyler

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2563-2571
Number of pages9
JournalAnnals of Surgical Oncology
Volume19
Issue number8
DOIs
StatePublished - Aug 2012
Externally publishedYes

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Melanoma
Extremities
Recurrence
Drug Therapy
Perfusion
Confidence Intervals
Survival
Databases

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma. / Sharma, Ketan; Beasley, Georgia; Turley, Ryan; Raymond, Amanda K.; Broadwater, Gloria; Peterson, Bercedis; Mosca, Paul; Tyler, Douglas.

In: Annals of Surgical Oncology, Vol. 19, No. 8, 08.2012, p. 2563-2571.

Research output: Contribution to journalArticle

Sharma, K, Beasley, G, Turley, R, Raymond, AK, Broadwater, G, Peterson, B, Mosca, P & Tyler, D 2012, 'Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma', Annals of Surgical Oncology, vol. 19, no. 8, pp. 2563-2571. https://doi.org/10.1245/s10434-012-2315-5
Sharma, Ketan ; Beasley, Georgia ; Turley, Ryan ; Raymond, Amanda K. ; Broadwater, Gloria ; Peterson, Bercedis ; Mosca, Paul ; Tyler, Douglas. / Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 8. pp. 2563-2571.
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abstract = "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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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

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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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