Isolated limb infusion for melanoma: A simple but effective alternative to isolated limb perfusion

Thompson, John F.; Kam, P. C. A.

doi:10.1002/jso.20112

Cited by 69 publications

(65 citation statements)

References 17 publications

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“…4,5 Isolated limb infusion (ILI) has been developed at the Sydney Melanoma Unit as a simplified and minimally invasive alternative to ILP. 6,7 In essence, ILI is a low-flow ILP performed via percutaneous catheters without oxygenation. We have previously shown that the outcomes of ILI are similar to those achieved by conventional ILP.…”

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confidence: 99%

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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BACKGROUND:Isolated limb infusion (ILI) is an effective and minimally invasive treatment option for delivering regional chemotherapy in patients with metastatic melanoma confined to a limb. Recurrent or progressive disease after an ILI, however, presents a challenge for further treatment. The value of repeat ILI in this situation has not been well documented.METHODS:Forty‐eight patients were identified who had been treated with a repeat ILI. In all patients, a cytotoxic combination of melphalan and actinomycin D was used.RESULTS:The median time between the 2 procedures was 11 months. The complete response (CR) rate after repeat ILI was 23%, compared with 31% after the initial ILI (P = .36). The overall response was 83%, compared with 75% after the first procedure (P = .32). The median duration of response was 11 months (10 months for patients with CR; P = .80), and median survival was 38 months. In those patients achieving a CR, the median survival was 68 months (P = .003). Toxicity after repeat ILI was increased, with 20 patients experiencing Wieberdink grade III limb toxicity (considerable erythema and edema with blistering) and 5 patients experiencing grade IV toxicity (threatened or actual compartment syndrome), whereas after the initial ILI these toxicity grades occurred in 14 patients and 1 patient, respectively (P = .03). No patient experienced grade V toxicity (requiring amputation).CONCLUSIONS:Repeat ILI is an attractive treatment option to achieve limb salvage in patients with inoperable recurrent or progressive melanoma after a previous ILI. It can be associated with significant short‐term regional toxicity, but is well tolerated by most patients, with satisfactory response rates. Cancer 2009. © 2009 American Cancer Society.

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Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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“…The significantly lower fluoroscopy time needed for the combined arterial and venous catheter placement during Arterial 0 3 (6) . 4613 Postoperative DVT 1 (7) 0 .2308…”

Section: Discussionmentioning

confidence: 99%

“…Conventional ILI was performed as described previously with insertion of both the arterial and venous catheters from the contralateral femoral approach. 6 For the simplified ipsilateral approach, the patient was initially placed in a prone position. Preprocedural ultrasonography was used to identify the popliteal vein in the extremity to be treated.…”

Section: Methodsmentioning

confidence: 99%

“…4 ILI evolved from the procedure known as isolated limb perfusion (ILP), a procedure that involved isolation of the limb's blood supply and perfusion with oxygenated blood and therapeutic agents. 5 ILI is essentially the same as ILP but does not require extracorporeal oxygenation, thus reducing the amount of operating room (OR) time needed and resources used. 6,7 Traditionally, arterial and venous access catheters are introduced from the contralateral limb under image guidance with catheter tips carefully positioned distal to the level of tourniquet pressure.…”

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confidence: 99%

“…5 ILI is essentially the same as ILP but does not require extracorporeal oxygenation, thus reducing the amount of operating room (OR) time needed and resources used. 6,7 Traditionally, arterial and venous access catheters are introduced from the contralateral limb under image guidance with catheter tips carefully positioned distal to the level of tourniquet pressure. Chemotherapy is infused for approximately 30-45 minutes, followed by a washout of the limb.…”

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Isolated limb infusion with cytotoxic agents: A simplified approach for venous access

Vyas

Avritscher

Ensor

et al. 2009

Cancer

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BACKGROUND: Isolated limb infusion (ILI) of cytotoxic agents is a regional therapy for cutaneous malignancies in a single extremity. Conventional ILI technique requires retrograde catheterization of the contralateral femoral vein. A novel modified ILI technique uses an ipsilateral popliteal venous approach. The purpose of this study was to compare the performance of ILI using the 2 different approaches. METHODS: Data from patients who underwent lower-extremity ILI at the authors' institution between October 2005 and June 2008 were retrospectively reviewed. The authors compared the 2 ILI approaches with regard to overall procedure time, fluoroscopy time, and the number of callbacks to the operating room (OR) for flow-related issues. The Student t test and Fisher exact test were used. Adverse events, including deep venous thrombosis (DVT) in the treated limb, were recorded. RESULTS: Between October 2005 and June 2008, 67 lower-extremity ILI procedures (15 using a contralateral venous access approach and 52 using an ipsilateral venous access approach) were performed in 62 patients (28 men and 34 women aged 31-82 years). The mean fluoroscopy times for the contralateral and ipsilateral groups were 17.9 and 8.3 minutes, respectively (P ¼ .0019). No significant difference in the overall procedure time and number of callbacks to the OR for flow-related issues between the 2 groups was identified. CONCLUSIONS: The ipsilateral popliteal venous approach is a simplified and safe ILI technique with significantly lower overall fluoroscopy procedure times required for catheter placement and no difference in catheter-related adverse events, when compared with the conventional contralateral approach. Cancer 2010;116:459-64.

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State of the science 60th anniversary review

Demierre

Sabel

Margolin

et al. 2008

Cancer

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Isolated limb infusion for melanoma: A simple but effective alternative to isolated limb perfusion

Cited by 69 publications

References 17 publications

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Isolated limb infusion with cytotoxic agents: A simplified approach for venous access

State of the science 60th anniversary review

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