Australian Multicenter Study of Isolated Limb Infusion for Melanoma

Hidde M. Kroon, Brendon J. Coventry, Mitchell H. Giles, Michael A. Henderson, David Speakman, Mark Wall, Andrew Barbour, Jonathan Serpell, Paul Paddle, Alexander G.J. Coventry, Thomas Sullivan, Bernard Mark Smithers, John F. Thompson

Research output: Contribution to journalArticle

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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.

LanguageEnglish
Pages1096-1103
Number of pages8
JournalAnnals of Surgical Oncology
Volume23
Issue number4
DOIs
Publication statusPublished - 1 Apr 2016
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Kroon, H. M., Coventry, B. J., Giles, M. H., Henderson, M. A., Speakman, D., Wall, M., ... Thompson, J. F. (2016). Australian Multicenter Study of Isolated Limb Infusion for Melanoma. Annals of Surgical Oncology, 23(4), 1096-1103. https://doi.org/10.1245/s10434-015-4969-2
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. / Australian Multicenter Study of Isolated Limb Infusion for Melanoma. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 4. pp. 1096-1103.
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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.",
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Kroon, HM, Coventry, BJ, Giles, MH, Henderson, MA, Speakman, D, Wall, M, Barbour, A, Serpell, J, Paddle, P, Coventry, AGJ, Sullivan, T, Smithers, BM & Thompson, JF 2016, 'Australian Multicenter Study of Isolated Limb Infusion for Melanoma', Annals of Surgical Oncology, vol. 23, no. 4, pp. 1096-1103. https://doi.org/10.1245/s10434-015-4969-2

Australian Multicenter Study of Isolated Limb Infusion for Melanoma. / 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.

In: Annals of Surgical Oncology, Vol. 23, No. 4, 01.04.2016, p. 1096-1103.

Research output: Contribution to journalArticle

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AU - Kroon, Hidde M.

AU - Coventry, Brendon J.

AU - Giles, Mitchell H.

AU - Henderson, Michael A.

AU - Speakman, David

AU - Wall, Mark

AU - Barbour, Andrew

AU - Serpell, Jonathan

AU - Paddle, Paul

AU - Coventry, Alexander G.J.

AU - Sullivan, Thomas

AU - Smithers, Bernard Mark

AU - Thompson, John F.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

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Kroon HM, Coventry BJ, Giles MH, Henderson MA, Speakman D, Wall M et al. Australian Multicenter Study of Isolated Limb Infusion for Melanoma. Annals of Surgical Oncology. 2016 Apr 1;23(4):1096-1103. https://doi.org/10.1245/s10434-015-4969-2