Australian Multicenter Study of Isolated Limb Infusion for Melanoma

Purpose Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Aus...

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Veröffentlicht in:Annals of surgical oncology 2016-04, Vol.23 (4), p.1096-1103
Hauptverfasser: Kroon, Hidde M., Coventry, Brendon J., Giles, Mitchell H., Henderson, Michael A., Speakman, David, Wall, Mark, Barbour, Andrew, Serpell, Jonathan, Paddle, Paul, Coventry, Alexander G. J., Sullivan, Thomas, Smithers, Bernard Mark, Thompson, John F.
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container_end_page 1103
container_issue 4
container_start_page 1096
container_title Annals of surgical oncology
container_volume 23
creator Kroon, Hidde M.
Coventry, Brendon J.
Giles, Mitchell H.
Henderson, Michael A.
Speakman, David
Wall, Mark
Barbour, Andrew
Serpell, Jonathan
Paddle, Paul
Coventry, Alexander G. J.
Sullivan, Thomas
Smithers, Bernard Mark
Thompson, John F.
description Purpose Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting. Patients and Methods The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months ( p  = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival. Conclusions This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.
doi_str_mv 10.1245/s10434-015-4969-2
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J. ; Sullivan, Thomas ; Smithers, Bernard Mark ; Thompson, John F.</creator><creatorcontrib>Kroon, Hidde M. ; Coventry, Brendon J. ; Giles, Mitchell H. ; Henderson, Michael A. ; Speakman, David ; Wall, Mark ; Barbour, Andrew ; Serpell, Jonathan ; Paddle, Paul ; Coventry, Alexander G. J. ; Sullivan, Thomas ; Smithers, Bernard Mark ; Thompson, John F.</creatorcontrib><description>Purpose Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting. Patients and Methods The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months ( p  = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival. Conclusions This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-015-4969-2</identifier><identifier>PMID: 26581203</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Australia ; Chemotherapy, Cancer, Regional Perfusion ; Dactinomycin - administration &amp; dosage ; Female ; Follow-Up Studies ; Humans ; Lower Extremity ; Male ; Medicine ; Medicine &amp; Public Health ; Melanoma - drug therapy ; Melanoma - pathology ; Melanomas ; Melphalan - administration &amp; dosage ; Middle Aged ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging ; Oncology ; Prognosis ; Prospective Studies ; Skin Neoplasms - drug therapy ; Skin Neoplasms - pathology ; Surgery ; Surgical Oncology ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2016-04, Vol.23 (4), p.1096-1103</ispartof><rights>Society of Surgical Oncology 2015</rights><rights>Society of Surgical Oncology 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-301946a3cc3dd203391ceca131a226cd94426c8e64309a80bc374968dca725413</citedby><cites>FETCH-LOGICAL-c372t-301946a3cc3dd203391ceca131a226cd94426c8e64309a80bc374968dca725413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-015-4969-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-015-4969-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26581203$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kroon, Hidde M.</creatorcontrib><creatorcontrib>Coventry, Brendon J.</creatorcontrib><creatorcontrib>Giles, Mitchell H.</creatorcontrib><creatorcontrib>Henderson, Michael A.</creatorcontrib><creatorcontrib>Speakman, David</creatorcontrib><creatorcontrib>Wall, Mark</creatorcontrib><creatorcontrib>Barbour, Andrew</creatorcontrib><creatorcontrib>Serpell, Jonathan</creatorcontrib><creatorcontrib>Paddle, Paul</creatorcontrib><creatorcontrib>Coventry, Alexander G. J.</creatorcontrib><creatorcontrib>Sullivan, Thomas</creatorcontrib><creatorcontrib>Smithers, Bernard Mark</creatorcontrib><creatorcontrib>Thompson, John F.</creatorcontrib><title>Australian Multicenter Study of Isolated Limb Infusion for Melanoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Purpose Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting. Patients and Methods The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months ( p  = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival. Conclusions This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. 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J.</creator><creator>Sullivan, Thomas</creator><creator>Smithers, Bernard Mark</creator><creator>Thompson, John F.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20160401</creationdate><title>Australian Multicenter Study of Isolated Limb Infusion for Melanoma</title><author>Kroon, Hidde M. ; Coventry, Brendon J. ; Giles, Mitchell H. ; Henderson, Michael A. ; Speakman, David ; Wall, Mark ; Barbour, Andrew ; Serpell, Jonathan ; Paddle, Paul ; Coventry, Alexander G. 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J.</au><au>Sullivan, Thomas</au><au>Smithers, Bernard Mark</au><au>Thompson, John F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Australian Multicenter Study of Isolated Limb Infusion for Melanoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>23</volume><issue>4</issue><spage>1096</spage><epage>1103</epage><pages>1096-1103</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Purpose Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting. Patients and Methods The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months ( p  = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival. Conclusions This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>26581203</pmid><doi>10.1245/s10434-015-4969-2</doi><tpages>8</tpages></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Australia
Chemotherapy, Cancer, Regional Perfusion
Dactinomycin - administration & dosage
Female
Follow-Up Studies
Humans
Lower Extremity
Male
Medicine
Medicine & Public Health
Melanoma - drug therapy
Melanoma - pathology
Melanomas
Melphalan - administration & dosage
Middle Aged
Neoplasm Recurrence, Local - drug therapy
Neoplasm Recurrence, Local - pathology
Neoplasm Staging
Oncology
Prognosis
Prospective Studies
Skin Neoplasms - drug therapy
Skin Neoplasms - pathology
Surgery
Surgical Oncology
Survival Rate
title Australian Multicenter Study of Isolated Limb Infusion for Melanoma
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