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Safety and Efficacy of Isolated Limb Perfusion in Elderly Melanoma Patients

From the Department of Surgery (EMN, BCV, OEN, BBRK), The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; and Department of Surgery (ANV, AMME), University Hospital Rotterdam/Daniel den Hoed Cancer Center, Rotterdam, The Netherlands.

Correspondence: Address correspondence and reprint requests to: E. M. Noorda, MD, Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Fax: 31-20-5122554; E-mail: e.noorda{at}nki.nl

Background: Older patients are assumed to have a higher risk of complications from isolated limb perfusion (ILP). A study was performed evaluating the safety and efficacy of ILP in patients older than 75 years with advanced melanoma of the limbs.

Methods: A total of 218 therapeutic ILPs with melphalan with or without tumor necrosis factor were performed in 202 patients with advanced measurable melanoma and were analyzed retrospectively. Fifty-three patients (28%) were 75 years or older.

Results: Complete response rates were 56% for those older than 75 years and 58% for the younger group (P = .79). Locoregional relapse occurred in 56% of the older group versus 51% in the younger group (P = .61). Limb toxicity, systemic toxicity, local complications, and long-term morbidity were similar in both age groups. Perioperative mortality was low, with one procedure-related death in the older group. Older patients stayed in the hospital for a median of 23 days (younger patients, 19 days; P < .01).

Conclusions: ILP results in similar response rates in the elderly with recurrent melanoma, without increased toxicity, complications, or long-term morbidity compared with younger patients. Older age in itself is not a contraindication for ILP.

Key Words: Melanoma • Regional perfusion • Chemotherapy • Aged • Drug toxicity

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