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Erschienen in: Annals of Surgical Oncology 4/2016

01.04.2016 | Melanomas

Australian Multicenter Study of Isolated Limb Infusion for Melanoma

verfasst von: Hidde M. Kroon, MD, PhD, Brendon J. Coventry, BMBS, PhD, FRACS, FACS, FRSM, Mitchell H. Giles, BMBS, Michael A. Henderson, MDDS, MD, BMed Sci, David Speakman, MDDS, FRACS, Mark Wall, BMBS, Andrew Barbour, MBBS, PhD, FRACS, Jonathan Serpell, MDDS, MD, FRACS, Paul Paddle, MBBS, Alexander G. J. Coventry, BMBS, Thomas Sullivan, MsC, Bernard Mark Smithers, MBBS, FRACS, FRCS, John F. Thompson, MBBS, BSC(Med), MD, FRACS, FACS

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2016

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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.
Literatur
1.
Zurück zum Zitat Australian Institute of Health and Welfare, and Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Australian Cancer Incidence and Mortality Workbooks-Melanoma. Cancer series no. 74. Cat. no. CAN 70. Canberra: Australian Institute of Health and Welfare; 2012. Australian Institute of Health and Welfare, and Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Australian Cancer Incidence and Mortality Workbooks-Melanoma. Cancer series no. 74. Cat. no. CAN 70. Canberra: Australian Institute of Health and Welfare; 2012.
2.
Zurück zum Zitat Francken AB, Accortt NA, Shaw HM, et al. Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol. 2008;15:1476–84.CrossRefPubMed Francken AB, Accortt NA, Shaw HM, et al. Prognosis and determinants of outcome following locoregional or distant recurrence in patients with cutaneous melanoma. Ann Surg Oncol. 2008;15:1476–84.CrossRefPubMed
3.
Zurück zum Zitat Testori A, Faries MB, Thompson JF, et al. Local and intralesional therapy of in-transit melanoma metastases. J Surg Oncol. 2011;104:391–6.CrossRefPubMed Testori A, Faries MB, Thompson JF, et al. Local and intralesional therapy of in-transit melanoma metastases. J Surg Oncol. 2011;104:391–6.CrossRefPubMed
4.
Zurück zum Zitat Moreno-Ramirez D, de la Cruz-Merino L, Ferrandiz L, et al. Isolated limb perfusion for malignant melanoma: systematic review on effectiveness and safety. Oncologist. 2010;15:416–27.CrossRefPubMedPubMedCentral Moreno-Ramirez D, de la Cruz-Merino L, Ferrandiz L, et al. Isolated limb perfusion for malignant melanoma: systematic review on effectiveness and safety. Oncologist. 2010;15:416–27.CrossRefPubMedPubMedCentral
5.
Zurück zum Zitat Thompson JF, Waugh RC, Saw RPM, et al. Isolated limb infusion with melphalan for recurrent limb melanoma: a simple alternative to isolated limb perfusion. Reg Cancer Treat. 1994;7:188–92. Thompson JF, Waugh RC, Saw RPM, et al. Isolated limb infusion with melphalan for recurrent limb melanoma: a simple alternative to isolated limb perfusion. Reg Cancer Treat. 1994;7:188–92.
6.
7.
Zurück zum Zitat Kroon HM, Lin DY, Kam PC, et al. Efficacy of repeat isolated limb infusion with melphalan and actinomycin-D for recurrent melanoma. Cancer. 2009;115:1932–40.CrossRefPubMed Kroon HM, Lin DY, Kam PC, et al. Efficacy of repeat isolated limb infusion with melphalan and actinomycin-D for recurrent melanoma. Cancer. 2009;115:1932–40.CrossRefPubMed
8.
Zurück zum Zitat Kroon HM, Huismans AM, Kam PCA, et al. Isolated limb infusion with melphalan and actinomycin D for melanoma: a systematic review. J Surg Oncol. 2014;109:348–51.CrossRefPubMed Kroon HM, Huismans AM, Kam PCA, et al. Isolated limb infusion with melphalan and actinomycin D for melanoma: a systematic review. J Surg Oncol. 2014;109:348–51.CrossRefPubMed
9.
Zurück zum Zitat Kroon HM, Moncrieff M, Kam PC, et al. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008;15:3003–13.CrossRefPubMed Kroon HM, Moncrieff M, Kam PC, et al. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008;15:3003–13.CrossRefPubMed
10.
Zurück zum Zitat Beasley GM, Caudle A, Petersen RP, et al. A multi-institutional experience of isolated limb infusion: defining response and toxicity in the US. J Am Coll Surg. 2009;208:706–15.CrossRefPubMed Beasley GM, Caudle A, Petersen RP, et al. A multi-institutional experience of isolated limb infusion: defining response and toxicity in the US. J Am Coll Surg. 2009;208:706–15.CrossRefPubMed
11.
Zurück zum Zitat Wong J, Chen YA, Fisher KJ, et al. Isolated limb infusion in a series of over infusions: a single-center experience. Ann Surg Oncol. 2013;20:1121–7.CrossRefPubMedPubMedCentral Wong J, Chen YA, Fisher KJ, et al. Isolated limb infusion in a series of over infusions: a single-center experience. Ann Surg Oncol. 2013;20:1121–7.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat Klaase JM, Kroon BB, van Geel AN, et al. Limb recurrence-free interval and survival in patients with recurrent melanoma of the extremities treated with normothermic isolated perfusion. J Am Coll Surg. 1994; 178:564–72.PubMed Klaase JM, Kroon BB, van Geel AN, et al. Limb recurrence-free interval and survival in patients with recurrent melanoma of the extremities treated with normothermic isolated perfusion. J Am Coll Surg. 1994; 178:564–72.PubMed
13.
Zurück zum Zitat Thompson JF, Kam PCA, de Wilt JHW, et al. Isolated limb infusion for melanoma. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 429–37. Thompson JF, Kam PCA, de Wilt JHW, et al. Isolated limb infusion for melanoma. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 429–37.
14.
Zurück zum Zitat Kroon HM, Huismans AM, Kam PCA, et al. Isolated limb infusion: technical aspects. J Surg Oncol. 2014;109:352–6.CrossRefPubMed Kroon HM, Huismans AM, Kam PCA, et al. Isolated limb infusion: technical aspects. J Surg Oncol. 2014;109:352–6.CrossRefPubMed
15.
Zurück zum Zitat Giles MH, Coventry BJ. Isolated limb infusion chemotherapy for melanoma: an overview of early experience at the Adelaide Melanoma Unit. Cancer Manag Res. 2013;5:243–9.PubMedPubMedCentral Giles MH, Coventry BJ. Isolated limb infusion chemotherapy for melanoma: an overview of early experience at the Adelaide Melanoma Unit. Cancer Manag Res. 2013;5:243–9.PubMedPubMedCentral
16.
Zurück zum Zitat Wieberdink J, Benckhuysen C, Braat RP, et al. Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions. Eur J Cancer Clin Oncol. 1982;18:905–10.CrossRefPubMed Wieberdink J, Benckhuysen C, Braat RP, et al. Dosimetry in isolation perfusion of the limbs by assessment of perfused tissue volume and grading of toxic tissue reactions. Eur J Cancer Clin Oncol. 1982;18:905–10.CrossRefPubMed
17.
Zurück zum Zitat Lai DTM, Ingvar C, Thompson JF. The value of monitoring serum creatine phosphokinase values following hyperthermic isolated limb perfusion for melanoma. Reg Cancer Treat. 1993;6:36–9. Lai DTM, Ingvar C, Thompson JF. The value of monitoring serum creatine phosphokinase values following hyperthermic isolated limb perfusion for melanoma. Reg Cancer Treat. 1993;6:36–9.
18.
Zurück zum Zitat World Health Organization. WHO handbook for reporting results of cancer treatments. WHO Offset Publication No. 48. Geneva: World Health Organization; 1979. World Health Organization. WHO handbook for reporting results of cancer treatments. WHO Offset Publication No. 48. Geneva: World Health Organization; 1979.
19.
Zurück zum Zitat Kaplan L, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1985;53:457–81.CrossRef Kaplan L, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1985;53:457–81.CrossRef
20.
Zurück zum Zitat Cox DR. Regression models and life table. J Stat Soc. 1972;34:187–220. Cox DR. Regression models and life table. J Stat Soc. 1972;34:187–220.
21.
Zurück zum Zitat Huismans AM, Kroon HM, Kam PC, et al. Does increased experience with isolated limb infusion for advanced limb melanoma influence outcome? A comparison of two treatment periods at a single institution. Ann Surg Oncol. 2011;18:1877–83.CrossRefPubMed Huismans AM, Kroon HM, Kam PC, et al. Does increased experience with isolated limb infusion for advanced limb melanoma influence outcome? A comparison of two treatment periods at a single institution. Ann Surg Oncol. 2011;18:1877–83.CrossRefPubMed
22.
Zurück zum Zitat Coventry BJ, Kroon HM, Giles MH, et al. Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma. J Surg Oncol. 2014;109:780–5.CrossRefPubMed Coventry BJ, Kroon HM, Giles MH, et al. Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma. J Surg Oncol. 2014;109:780–5.CrossRefPubMed
23.
Zurück zum Zitat Beasley GM, Sharma K, Wong J, et al. A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower extremity melphalan-based isolated limb infusion. Cancer. 2012;118:6136–43.CrossRefPubMed Beasley GM, Sharma K, Wong J, et al. A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower extremity melphalan-based isolated limb infusion. Cancer. 2012;118:6136–43.CrossRefPubMed
24.
Zurück zum Zitat Barbour AP, Thomas J, Suffolk J, et al. Isolated limb infusion for malignant melanoma: predictors of response and outcome. Ann Surg Oncol. 2009;16:3463–72.CrossRefPubMed Barbour AP, Thomas J, Suffolk J, et al. Isolated limb infusion for malignant melanoma: predictors of response and outcome. Ann Surg Oncol. 2009;16:3463–72.CrossRefPubMed
25.
Zurück zum Zitat Sanki A, Kroon HM, Kam PCA, et al. Isolated limb perfusion and isolated limb infusion for malignant lesions of the extremities. Curr Probl Surg. 2011;48:371–430.CrossRefPubMed Sanki A, Kroon HM, Kam PCA, et al. Isolated limb perfusion and isolated limb infusion for malignant lesions of the extremities. Curr Probl Surg. 2011;48:371–430.CrossRefPubMed
26.
Zurück zum Zitat Vrouenraets BC, Kroon BBR, Nieweg OE, et al. Isolated limb perfusion for melanoma: results and complications, toxicity. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 410–28. Vrouenraets BC, Kroon BBR, Nieweg OE, et al. Isolated limb perfusion for melanoma: results and complications, toxicity. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004: pp. 410–28.
27.
Zurück zum Zitat Kroon HM, Moncrieff M, Kam PC, et al. Factors predictive of acute regional toxicity after isolated limb infusion with melphalan and actinomycin D in melanoma patients. Ann Surg Oncol. 2009;16:1184–92.CrossRefPubMed Kroon HM, Moncrieff M, Kam PC, et al. Factors predictive of acute regional toxicity after isolated limb infusion with melphalan and actinomycin D in melanoma patients. Ann Surg Oncol. 2009;16:1184–92.CrossRefPubMed
28.
Zurück zum Zitat Santillan AA, Delman KA, Beasley GM, et al. Predictive factors of regional toxicity and serum creatine phosphokinase levels after isolated limb infusion for melanoma: a multi-institutional analysis. Ann Surg Oncol. 2009;16:2570–8.CrossRefPubMed Santillan AA, Delman KA, Beasley GM, et al. Predictive factors of regional toxicity and serum creatine phosphokinase levels after isolated limb infusion for melanoma: a multi-institutional analysis. Ann Surg Oncol. 2009;16:2570–8.CrossRefPubMed
29.
Zurück zum Zitat Scott RN, Blackie R, Kerr DJ, et al. Melphalan in isolated limb perfusion for malignant melanoma, bolus or divided dose, tissue levels, the pH effect. In: Jakesz R, Rainer H, editos. Progress in regional cancer therapy. Berlin: Springer; 1990: pp. 195–200.CrossRef Scott RN, Blackie R, Kerr DJ, et al. Melphalan in isolated limb perfusion for malignant melanoma, bolus or divided dose, tissue levels, the pH effect. In: Jakesz R, Rainer H, editos. Progress in regional cancer therapy. Berlin: Springer; 1990: pp. 195–200.CrossRef
30.
Zurück zum Zitat Klaase JM, Kroon BBR, Beijnen JH, et al. Melphalan tissue concentrations in patients treated with regional isolated perfusion for melanoma of the lower limb. Br J Cancer. 1994;70:151–3.CrossRefPubMedPubMedCentral Klaase JM, Kroon BBR, Beijnen JH, et al. Melphalan tissue concentrations in patients treated with regional isolated perfusion for melanoma of the lower limb. Br J Cancer. 1994;70:151–3.CrossRefPubMedPubMedCentral
31.
Zurück zum Zitat Huismans AM, Kroon HM, Haydu LE, et al. Is melphalan dose adjustment according to ideal body weight useful in isolated limb infusion for melanoma? Ann Surg Oncol. 2012;19:3050–6.CrossRefPubMed Huismans AM, Kroon HM, Haydu LE, et al. Is melphalan dose adjustment according to ideal body weight useful in isolated limb infusion for melanoma? Ann Surg Oncol. 2012;19:3050–6.CrossRefPubMed
32.
Zurück zum Zitat McMahon N, Cheng TY, Beasley GM, et al. Optimizing melphalan pharmacokinetics in regional melanoma therapy: does correcting for ideal body weight alter regional response or toxicity? Ann Surg Oncol. 2009;16:953–61.CrossRefPubMed McMahon N, Cheng TY, Beasley GM, et al. Optimizing melphalan pharmacokinetics in regional melanoma therapy: does correcting for ideal body weight alter regional response or toxicity? Ann Surg Oncol. 2009;16:953–61.CrossRefPubMed
33.
Zurück zum Zitat Siemann DW, Chapman M, Beikirch A. Effects of oxygenation and pH on tumor cell response to alkylating chemotherapy. Int J Radiat Oncol Biol Phys. 1991;20:287–9.CrossRefPubMed Siemann DW, Chapman M, Beikirch A. Effects of oxygenation and pH on tumor cell response to alkylating chemotherapy. Int J Radiat Oncol Biol Phys. 1991;20:287–9.CrossRefPubMed
34.
Zurück zum Zitat Wu ZY, Smithers BM, Parsons PG, et al. The effects of perfusion conditions on melphalan distribution in the isolated perfused rat hindlimb bearing a human melanoma xenograft. Br J Cancer. 1997;75:1160–6.CrossRefPubMedPubMedCentral Wu ZY, Smithers BM, Parsons PG, et al. The effects of perfusion conditions on melphalan distribution in the isolated perfused rat hindlimb bearing a human melanoma xenograft. Br J Cancer. 1997;75:1160–6.CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Koops HS, Vaglini M, Suciu S, et al. Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. J Clin Oncol. 1998;16:2906–12.PubMed Koops HS, Vaglini M, Suciu S, et al. Prophylactic isolated limb perfusion for localized, high-risk limb melanoma: results of a multicenter randomized phase III trial. J Clin Oncol. 1998;16:2906–12.PubMed
36.
Zurück zum Zitat Wong J, Ann Chen Y, Fisher KJ, et al. Resection of residual disease after isolated limb infusion (ILI) is equivalent to a complete response after ILI-alone in advanced extremity melanoma. Ann Surg Oncol. 2014;21:650–5.CrossRefPubMedPubMedCentral Wong J, Ann Chen Y, Fisher KJ, et al. Resection of residual disease after isolated limb infusion (ILI) is equivalent to a complete response after ILI-alone in advanced extremity melanoma. Ann Surg Oncol. 2014;21:650–5.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Thompson JF, Agarwala SS, Smithers BM, et al. Phase 2 study of intralesional PV-10 in refractory metastatic melanoma. Ann Surg Oncol. 2015;22:2135–42.CrossRefPubMedPubMedCentral Thompson JF, Agarwala SS, Smithers BM, et al. Phase 2 study of intralesional PV-10 in refractory metastatic melanoma. Ann Surg Oncol. 2015;22:2135–42.CrossRefPubMedPubMedCentral
38.
Zurück zum Zitat Damian DL, Saw RP, Thompson JF. Topical immunotherapy with diphencyprone for in transit and cutaneously metastatic melanoma. J Surg Oncol. 2014;109:308–13.CrossRefPubMed Damian DL, Saw RP, Thompson JF. Topical immunotherapy with diphencyprone for in transit and cutaneously metastatic melanoma. J Surg Oncol. 2014;109:308–13.CrossRefPubMed
39.
Zurück zum Zitat Muilenburg DJ, Beasley GM, Thompson ZJ, et al. Burden of disease predicts response to isolated limb infusion with melphalan and actinomycin d in melanoma. Ann Surg Oncol. 2015;22:482–8.CrossRefPubMedPubMedCentral Muilenburg DJ, Beasley GM, Thompson ZJ, et al. Burden of disease predicts response to isolated limb infusion with melphalan and actinomycin d in melanoma. Ann Surg Oncol. 2015;22:482–8.CrossRefPubMedPubMedCentral
40.
Zurück zum Zitat Beasley GM, Coleman AP, Raymond A, et al. A phase I multi-institutional study of systemic sorafenib in conjunction with regional melphalan for in-transit melanoma of the extremity. Ann Surg Oncol. 2012;19:3896–905.CrossRefPubMedPubMedCentral Beasley GM, Coleman AP, Raymond A, et al. A phase I multi-institutional study of systemic sorafenib in conjunction with regional melphalan for in-transit melanoma of the extremity. Ann Surg Oncol. 2012;19:3896–905.CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Beasley GM, Riboh JC, Augustine CK, et al. Prospective multicenter phase II trial of systemic ADH-1 in combination with melphalan via isolated limb infusion in patients with advanced extremity melanoma. J Clin Oncol. 2011;29:1210–5.CrossRefPubMedPubMedCentral Beasley GM, Riboh JC, Augustine CK, et al. Prospective multicenter phase II trial of systemic ADH-1 in combination with melphalan via isolated limb infusion in patients with advanced extremity melanoma. J Clin Oncol. 2011;29:1210–5.CrossRefPubMedPubMedCentral
42.
Zurück zum Zitat Coventry BJ, Ashdown ML. Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation. Cancer Manag Res. 2012;4:137–49.CrossRefPubMedPubMedCentral Coventry BJ, Ashdown ML. Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation. Cancer Manag Res. 2012;4:137–49.CrossRefPubMedPubMedCentral
Metadaten
Titel
Australian Multicenter Study of Isolated Limb Infusion for Melanoma
verfasst von
Hidde M. Kroon, MD, PhD
Brendon J. Coventry, BMBS, PhD, FRACS, FACS, FRSM
Mitchell H. Giles, BMBS
Michael A. Henderson, MDDS, MD, BMed Sci
David Speakman, MDDS, FRACS
Mark Wall, BMBS
Andrew Barbour, MBBS, PhD, FRACS
Jonathan Serpell, MDDS, MD, FRACS
Paul Paddle, MBBS
Alexander G. J. Coventry, BMBS
Thomas Sullivan, MsC
Bernard Mark Smithers, MBBS, FRACS, FRCS
John F. Thompson, MBBS, BSC(Med), MD, FRACS, FACS
Publikationsdatum
01.04.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4969-2

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