This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kroon, H. M. Articles by Thompson, J. F. Search for Related Content PubMed Articles by Kroon, H. M. Articles by Thompson, J. F.

Outcomes Following Isolated Limb Infusion for Melanoma. A 14-Year Experience

¹ Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
² Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia
³ Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
⁴ Discipline of Anaesthetics, The University of Sydney, Sydney, NSW, Australia

Correspondence: Address correspondence and reprint requests to: John F. Thompson, MD; E-mail: john.thompson{at}smu.org.au

Background: Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation.

Methods: From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20–30 min under mild hyperthermic conditions (38–39°C).

Results: The majority of patients (62%) were female. Their average age was 74 years (range 29–93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable out-come were achievement of CR, stage of disease, thickness of primary melanoma, the CO₂ level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema).

Conclusion: The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.

Key Words: Isolated limb infusion • Hypoxia • Metastatic melanoma • Melphalan • Actinomycin-D • Regional chemotherapy