Predictors of outcome after hyperthermic isolated limb perfusion: Role of tumor response

Thomas A. Aloia, Elizabeth Grubbs, Mark Onaitis, Paul J. Mosca, Tsung Yen Cheng, Hilliard Seigler, Douglas Tyler

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Hypothesis: Analysis of multiple clinical and pathological factors in patients undergoing therapeutic hyperthermic isolated limb perfusion for extremity melanoma can identify variables with prognostic significance. Design: Retrospective review of a prospectively collected limb perfusion database with a median follow-up interval of 32.2 months. Setting: Single-institution tertiary care surgical oncology unit. Patients: We report a series of 59 consecutive therapeutic hyperthermic isolated limb perfusion treatments (14 upper extremity and 45 lower extremity) in 54 patients with melanoma from January 1, 1995, through December 31, 2002, using a standard melphalan dosing protocol. At the time of perfusion, 31 cases had fewer than 10 lesions, with none greater than 3 cm in diameter. The remaining 28 cases had 10 or more lesions or at least 1 lesion greater than 3 cm in diameter. Main Outcome Measures: Response, recurrence, and survival were assessed in relation to multiple demographic, clinical, and technical variables using X2, log-rank, and Kaplan-Meier survival analyses. Results: The 3-year survival for the entire cohort was 54%. Thirty-three (56%) of the 59 perfusion treatments resulted in a persistent complete response of at least 6 months' duration. Statistical analysis showed that patients with no evidence of regional nodal involvement had a significantly lower incidence of distant recurrence (P=.02). Those patients achieving a complete response to therapy had a survival advantage (P=.03). Conclusion: In patients undergoing therapeutic hyperthermic isolated limb perfusion for in-transit melanoma, the ability to achieve a complete response following treatment, independent of regional nodal status, was the strongest predictor of long-term survival.

Original languageEnglish (US)
Pages (from-to)1115-1120
Number of pages6
JournalArchives of Surgery
Volume140
Issue number11
DOIs
StatePublished - Nov 2005
Externally publishedYes

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Extremities
Perfusion
Neoplasms
Melanoma
Survival
Therapeutics
Recurrence
Melphalan
Kaplan-Meier Estimate
Tertiary Healthcare
Survival Analysis
Upper Extremity
Lower Extremity
Demography
Outcome Assessment (Health Care)
Databases
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Aloia, T. A., Grubbs, E., Onaitis, M., Mosca, P. J., Cheng, T. Y., Seigler, H., & Tyler, D. (2005). Predictors of outcome after hyperthermic isolated limb perfusion: Role of tumor response. Archives of Surgery, 140(11), 1115-1120. https://doi.org/10.1001/archsurg.140.11.1115

Predictors of outcome after hyperthermic isolated limb perfusion : Role of tumor response. / Aloia, Thomas A.; Grubbs, Elizabeth; Onaitis, Mark; Mosca, Paul J.; Cheng, Tsung Yen; Seigler, Hilliard; Tyler, Douglas.

In: Archives of Surgery, Vol. 140, No. 11, 11.2005, p. 1115-1120.

Research output: Contribution to journalArticle

Aloia, TA, Grubbs, E, Onaitis, M, Mosca, PJ, Cheng, TY, Seigler, H & Tyler, D 2005, 'Predictors of outcome after hyperthermic isolated limb perfusion: Role of tumor response', Archives of Surgery, vol. 140, no. 11, pp. 1115-1120. https://doi.org/10.1001/archsurg.140.11.1115
Aloia, Thomas A. ; Grubbs, Elizabeth ; Onaitis, Mark ; Mosca, Paul J. ; Cheng, Tsung Yen ; Seigler, Hilliard ; Tyler, Douglas. / Predictors of outcome after hyperthermic isolated limb perfusion : Role of tumor response. In: Archives of Surgery. 2005 ; Vol. 140, No. 11. pp. 1115-1120.
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abstract = "Hypothesis: Analysis of multiple clinical and pathological factors in patients undergoing therapeutic hyperthermic isolated limb perfusion for extremity melanoma can identify variables with prognostic significance. Design: Retrospective review of a prospectively collected limb perfusion database with a median follow-up interval of 32.2 months. Setting: Single-institution tertiary care surgical oncology unit. Patients: We report a series of 59 consecutive therapeutic hyperthermic isolated limb perfusion treatments (14 upper extremity and 45 lower extremity) in 54 patients with melanoma from January 1, 1995, through December 31, 2002, using a standard melphalan dosing protocol. At the time of perfusion, 31 cases had fewer than 10 lesions, with none greater than 3 cm in diameter. The remaining 28 cases had 10 or more lesions or at least 1 lesion greater than 3 cm in diameter. Main Outcome Measures: Response, recurrence, and survival were assessed in relation to multiple demographic, clinical, and technical variables using X2, log-rank, and Kaplan-Meier survival analyses. Results: The 3-year survival for the entire cohort was 54{\%}. Thirty-three (56{\%}) of the 59 perfusion treatments resulted in a persistent complete response of at least 6 months' duration. Statistical analysis showed that patients with no evidence of regional nodal involvement had a significantly lower incidence of distant recurrence (P=.02). Those patients achieving a complete response to therapy had a survival advantage (P=.03). Conclusion: In patients undergoing therapeutic hyperthermic isolated limb perfusion for in-transit melanoma, the ability to achieve a complete response following treatment, independent of regional nodal status, was the strongest predictor of long-term survival.",
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