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Isolated Limb Infusion for In-Transit Malignant Melanoma of the Extremity: A Well-Tolerated but Less Effective Alternative to Hyperthermic Isolated Limb Perfusion

¹ Department of Surgery, Duke University Medical Center, Box 3118, Durham, NC 27710, USA
² Department of Surgery, Methodist Weill Cornell Hospital, Houston, TX, USA
³ Department of Basic Pharmaceutical Sciences, School of Pharmacy and Cancer Center, West Virginia University, Morgantown, WV, USA
⁴ Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan

Correspondence: Address correspondence and reprint requests to: Douglas S. Tyler, MD; E-mail: tyler002{at}acpub.duke.edu

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.

Key Words: Isolated limb infusion • Melanoma • Regional chemotherapy

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				D. Tyler Regional Therapeutic Strategies in Melanoma: Not Just Local Disease Control, but an Opportunity to Develop Novel Therapeutic Strategies with Potential Implications for Systemic Therapy Ann. Surg. Oncol., November 1, 2008; 15(11): 2987 - 2990. [Full Text] [PDF]