Management of Extremity Recurrences After Complete Responses to Isolated Limb Perfusion in Patients With Melanoma

Feldman, Andrew L.; Alexander, H. Richard; Bartlett, David L.; Fraker, Douglas L.; Libutti, Steven K.

doi:10.1007/s10434-999-0562-x

Cited by 37 publications

(14 citation statements)

References 13 publications

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“…In view of these results the treating surgeon may have tended to increase the drug dose slightly for repeat ILI in the hope of attaining an optimal result in this difficult to treat patient group. Although CR rates are lower, OR, duration of response and survival are comparable to those reported after repeat ILP for recurrent limb disease [7,59,60]. It can be concluded that a repeat ILI procedure can be of value if limb disease progresses or recurs after an initial ILI.…”

Section: Repeat Isolated Limb Infusionsupporting

confidence: 70%

Isolated limb infusion: A review

Kroon

Thompson

2009

Journal of Surgical Oncology

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Isolated limb perfusion is the preferred treatment option for locally advanced melanoma and sarcoma confined to a limb. This treatment results in high response rates with a satisfying duration of response in both tumours. A drawback of isolated limb perfusion, however, is the invasive and complex character of the procedure.Isolated limb infusion has been designed as a minimally invasive alternative to isolated limb perfusion. Treatment results of this simple technique, reported by various centres worldwide, show comparable response rates for melanoma and sarcoma. Therefore isolated limb infusion may replace isolated limb perfusion in the future as the preferred treatment option for these locally advanced limb tumours.

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Section: Repeat Isolated Limb Infusionsupporting

confidence: 70%

Isolated limb infusion: A review

Kroon

Thompson

2009

Journal of Surgical Oncology

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“…11,12,22,23 The advantage of ILI compared with other local treatments is that the whole area at risk of recurrence is treated, with the possibility of eradicating microscopic disease that may be present in the affected limb. 33,34 The increased median duration of response after ILI and ILP…”

Section: Discussionmentioning

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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“…In 11 studies analyzing 544 hyperthermic ILPs, the median CR rate was 61.80% (range, 36.00%-89.00%) [14, 16 -19, 22, 25, 26, 29 -31]; 61.03% of the hyperthermic perfusions (n ϭ 332 perfusions) were applied with the double-agent melphalan plus TNF regimen [14,18,19,22,25,26,29,30]. The median CR rate to normothermic ILP, as shown in two studies analyzing 303 normothermic regimens with melphalan, was 47.00% (range, 42.00%-76.00%).…”

Section: Clinical Responsementioning

confidence: 99%

“…Valid data on the effectiveness of ILP in terms of clinical response were yielded by 20 studies analyzing 1,587 ILPs, reporting a median OR rate of 90.35% (range, 64.00%-100.00%) with a median CR rate of 58.20% (range, 25.00%-89.00%) [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] (Table 3).…”

Section: Clinical Responsementioning

confidence: 99%

Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

et al. 2010

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After completing this course, the reader will be able to:1. Compare the response rate of ILP with melphalan and TNF to the response rate of ILP with single-agent melphalan in patients with unresectable locally advanced melanoma of the limbs.2. Compare the clinical response rates of repeated ILP after a recurrence or PR to a first ILP to clinical response rates after first ILP in patients with unresectable locally advanced melanoma of the limbs.3. In patients with unresectable malignant melanoma of the limbs, consider use of ILP to avoid amputation.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACT

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Management of Extremity Recurrences After Complete Responses to Isolated Limb Perfusion in Patients With Melanoma

Cited by 37 publications

References 13 publications

Isolated limb infusion: A review

Isolated limb infusion: A review

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

Isolated Limb Perfusion for Malignant Melanoma: Systematic Review on Effectiveness and Safety

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