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Prognostic Factors After Isolated Limb Infusion With Cytotoxic Agents for Melanoma

From the Sydney Melanoma Unit (PL, AD, JFT) and the Department of Anaesthetics (PCAK), Royal Prince Alfred Hospital; and the Department of Surgery (JFT), University of Sydney, Sydney, New South Wales, Australia.

Correspondence: Address correspondence and reprint requests to: J. F. Thompson, MD, Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Australia; Fax: 61-2-9550-6316; E-mail: john{at}mel.rpa.cs.nsw.gov.au

Background: Isolated limb perfusion (ILP) with cytotoxic agents is a remarkably effective but complex technique used to treat locally recurrent and metastatic melanoma confined to a limb. Isolated limb infusion (ILI), essentially a low-flow ILP performed without oxygenation via percutaneous catheters, has been developed as a simpler alternative.

Methods: The outcome in 135 patients treated by ILI was reviewed.

Results: The overall response rate in the treated limb was 85% (complete response [CR] rate 41%, partial response rate 44%). Median response duration response was 16 months (24 months for patients with CR). Median patient survival was 34 months. In those with a CR, the median survival was 42 months. CR rate and survival time decreased with increasing disease stage. Patients aged >70 years had a better overall response than younger patients. On multivariate analysis, factors associated with an improved outcome were a lower stage of disease, a final limb temperature >37.8°C, and a tourniquet time >40 minutes.

Conclusions: The frequency and duration of responses after ILI were comparable to those achieved by conventional ILP. The ILI technique is particularly useful for older patients who might not be considered suitable for conventional ILP.

Key Words: Hypoxia • Isolated limb infusion • Melanoma • Melphalan • Prognostic factors • Regional chemotherapy

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