Annals of Surgical Oncology

, Volume 16, Issue 5, pp 1193–1201 | Cite as

Isolated Limb Infusion as Palliative Treatment for Advanced Limb Disease in Patients with AJCC Stage IV Melanoma

  • Hidde M. Kroon
  • D-Yin Lin
  • Peter C. A. Kam
  • John F. Thompson
Melanomas

Abstract

Introduction

In the treatment of patients with advanced limb melanoma a major treatment dilemma can arise when distant metastases are present also. Isolated limb infusion (ILI) has proved to be a useful limb-saving treatment and could potentially be of palliative value in patients with American Joint Committee on Cancer (AJCC) stage IV melanoma.

Methods

We identified 37 patients with advanced symptomatic limb disease as well as documented distant metastases at the time of their ILI. In all patients a drug combination of melphalan and actinomycin D was used.

Results

Fifty one percent had visceral distant metastases and 49% had cutaneous distant metastases only. The overall response rate in the treated limb was 76% [complete response (CR) rate 22%, partial response (PR) rate 54%]. Median response duration was 11 months (28 months for patients with CR; p = 0.08). Median survival after CR was 22 months, 17 months after PR, and only 4 months for those with stable or progressive disease (p = 0.002). Patients with visceral distant metastases had a significantly decreased survival compared with those with cutaneous distant metastases only (8 and 21 months, respectively; p = 0.03). Limb salvage was achieved in 86% of the patients. The procedure was well tolerated, with only one patient developing Wieberdink grade IV toxicity (threatened/actual compartment syndrome) and none requiring amputation as a result of the procedure (grade V toxicity).

Conclusions

Minimally invasive ILI can effectively be used as palliative treatment to provide local tumor control and limb salvage in stage IV melanoma patients with advanced, symptomatic limb disease.

Keywords

Melanoma Isolate Limb Perfusion Isolate Limb Infusion Overall Response Sydney Melanoma Unit 

Notes

Acknowledgments

Hidde Kroon is supported by grants from, Haak Bastiaanse-Kuneman Stichting, Stichting Fundatie van de Vrijvrouwe van Renswoude te ‘s-Gravenhage, Stichting Sacha Swarttouw-Heijmans, KWF Kankerbestrijding, Stichting Prof. Michaël-van Vloten Fonds, Amgen Netherlands BV, University Medical Center Groningen/Faculty of Medical Sciences of the University of Groningen, the Melanoma Foundation of the University of Sydney and Melanoma Institute Australia.

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Hidde M. Kroon
    • 1
  • D-Yin Lin
    • 1
  • Peter C. A. Kam
    • 2
    • 3
  • John F. Thompson
    • 1
    • 4
  1. 1.Sydney Melanoma Unit and Melanoma Institute Australia, Sydney Cancer CentreRoyal Prince Alfred HospitalSydneyAustralia
  2. 2.Department of Anaesthetics, Royal Prince Alfred Hospital University of SydneySydneyAustralia
  3. 3.Disciplines of AnaestheticsThe University of SydneySydneyAustralia
  4. 4.Disciplines of SurgeryThe University of SydneySydneyAustralia

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