Major Amputation for Irresectable Extremity Melanoma After Failure of Isolated Limb Infusion

Kroon, Hidde M.; Lin, D-Yin; Kam, P. C. A.; Thompson, John F.

doi:10.1245/s10434-009-0394-8

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…Table summarizes the key data for each modality and presents the pooled results including the weighted ORR and meta‐analysis data. Assessed studies included: randomized controlled trials, nonrandomized phase I and II comparative and noncomparative studies, and prospective or retrospective case series (NHMRC levels II–IV evidence; Tables S2‐S9) . Only two therapies: amputation and topical imiquimod, were suitable for formal meta‐analysis ( I 2 value ≤ 40%).…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma

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Lonne

Sparks

et al. 2019

Journal of Surgical Oncology

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Background and Objectives In‐transit melanoma (ITM) metastases present a therapeutic challenge and management decisions can be difficult. There are multiple treatments available, with differing efficacy, and supported by different levels of evidence. The primary objective was to perform a systematic review and where suitable, a meta‐analysis of the literature reporting on the use of locoregional treatments for the management of ITM. Methods An independent review was conducted including a comprehensive search of the National Library of Medicine using PubMed, MEDLINE, Embase, and Cochrane Library databases. Key data were tabulated, synthesized and pooled to calculate relevant weighted effect sizes for each therapy using random‐effect models. The statistical heterogeneity was calculated using the Higgins' method. Results Of the initial 32 612 articles identified, 57 original articles satisfied eligibility criteria. Eight treatment modalities were identified comprising: amputation (7); hyperthermic isolated limb perfusion (15); isolated limb infusion (8); carbon dioxide laser (9); PV‐10 intralesional therapy (5); IL‐2 intralesional therapy (8); imiquimod (7); diphenylcyclopropenone (3). Only amputation and topical imiquimod were suitable for formal meta‐analysis. Conclusions All of the assessed therapies have significant selection bias. Variable levels of evidence support the ongoing use of locoregional treatments and these may significantly improve disease‐free survival.

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Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma

Read

Lonne

Sparks

et al. 2019

Journal of Surgical Oncology

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“…Major limb amputations are often used when limb salvage strategies, such as isolated limb infusion, isolated limb perfusion, and local treatments, including intrafocal injection and radiotherapy, are exhausted 11 . Patients who undergo radical amputation can achieve 5‐year survival rate at about 15%–30% 7,8 . Causes of death after amputation include melanoma metastasis, recurrence, complications, and the patient's health problems 13 .…”

Section: Discussionmentioning

confidence: 99%

Development and validation of two online dynamic nomograms for patients with non‐distant metastatic cutaneous melanoma based on surgical approaches

Wang,

Chen,

Sun

et al. 2023

Cancer Medicine

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Background and ObjectivesSurgery is an essential treatment for non‐distant metastatic cutaneous melanoma (NMCM). We aim to construct and validate prognostic nomograms based on surgical approaches and the clinicopathological characteristics of NMCM patients.MethodsData of patients diagnosed with cutaneous melanoma from 2004 to 2015 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Two online nomograms were constructed to predict the 3, 5‐year melanoma‐specific survival (MSS) for NMCM patients based on the surgical approaches. These nomograms were evaluated by the dynamic Harrell's concordance index (C‐index), decision curve analysis and clinical impact curve. Both internal and external data verification were conducted.ResultsA total of 14,091 NMCM cases were included in this study. The C‐index of the nomograms for the excisional surgery group and amputation group were 0.818 and 0.806, respectively, and 0.763 and 0.731, respectively, in our hospital data validation. After internal and bootstrap verification, our two nomograms showed good accuracy and practicality.ConclusionNMCM patients exhibited equal survival rates independent of resection margin size, while those who needed amputation had worse survival rates. We generated two online nomograms distinguished by surgical approach to predict NMCM patient survival based on clinicopathological characteristics.

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“…In a study of 14 patients treated at MIA who had persistent disease or disease recurrence following ILI and underwent limb amputation, an ORR of 71% was seen with a median duration of response of 7 months. The median time from ILI to amputation was 11-months(20). Median survival following amputation was 13 months, range 1-84 months; however, effective symptom relief was achieved in all patients (20).…”

Section: Discussionmentioning

confidence: 99%

“…The median time from ILI to amputation was 11-months(20). Median survival following amputation was 13 months, range 1-84 months; however, effective symptom relief was achieved in all patients (20). Clearly, a role for surgical intervention exists following failed ILI for control of limb disease from melanoma.…”

Section: Discussionmentioning

confidence: 99%

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

et al. 2013

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Introduction Isolated limb infusion (ILI) is a limb-preserving treatment for in-transit extremity melanoma. The benefit of resecting residual disease following ILI is unclear. Methods A multi-institutional experience was analyzed comparing patients who underwent ILI plus resection of residual disease (ILI+RES) versus ILI-alone. Results 176 patients were included: 154 ILI-alone and 22 ILI+RES. There were no differences between the groups with respect to gender, age, extremity affected, or time from diagnosis to ILI. All surgical resections were performed as an outpatient procedure, separate from the ILI. Within the ILI+RES group, fifteen (68%) had a partial response (PR), two (9%) stable disease (SD), and 5 (23%) progressive disease (PD). The ILI-alone group had 52 (34%) CR, 30 (19%) PR, 15 (10%) SD, and 46 (30%) PD. Eleven (7%) ILI-alone patients did not have 3-month response available for review. Evaluating overall survival (OS) from date of ILI, the ILI-alone group had a median OS of 30.9 months, whereas the ILI+RES group had not reached median OS, p=0.304. Although the ILI+RES group had a slightly longer disease free survival (DFS) compared to those with a CR after ILI-alone (12.4 vs. 9.6), this was not statistically significant, p=0.978. Within the ILI+RES group, those with an initial PR following ILI had improved DFS vs. those with SD or PD following ILI, p<0.0001. Conclusion Resection of residual disease following ILI offers a DFS and OS similar to those who have a CR after ILI-alone, and may offer a treatment strategy that benefits more patients undergoing ILI.

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Major Amputation for Irresectable Extremity Melanoma After Failure of Isolated Limb Infusion

Abstract: Amputation following upper extremity ILI is more common compared to lower extremity ILI. Amputation may provide effective long-term palliation in selected patients when there is extensive inoperable progressive or recurrent disease after ILI.

Cited by 14 publications

References 14 publications

A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma

A systematic review and meta‐analysis of locoregional treatments for in‐transit melanoma

Development and validation of two online dynamic nomograms for patients with non‐distant metastatic cutaneous melanoma based on surgical approaches

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

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