Isolated Limb Infusion as Palliative Treatment for Advanced Limb Disease in Patients with AJCC Stage IV Melanoma
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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.
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.
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).
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.
KeywordsMelanoma Isolate Limb Perfusion Isolate Limb Infusion Overall Response Sydney Melanoma Unit
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.
- 4.Thompson JF, Kam PCA, de Wilt JHW, Lindnér P. Isolated limb infusion for melanoma. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004. p. 429–37.Google Scholar
- 5.Kroon HM, Moncrieff M, Kam PC, Thompson JF. Outcomes following isolated limb infusion for melanoma. A 14-year experience. Ann Surg Oncol. 2008;15:2749–56.Google Scholar
- 7.American Joint Committee on Cancer. Malignant melanoma of the skin. In: Kleming I, Cooper J, Henson D, et al., editors. AJCC cancer staging manual. Philadelphia: J.B. Lippincott; 1992. p. 143–8.Google Scholar
- 12.Thompson JF, Waugh RC, Saw RPM, Kam PCA. Isolated limb infusion with melphalan for recurrent limb melanoma: a simple alternative to isolated limb perfusion. Reg Cancer Treat. 1994;7:188–92.Google Scholar
- 16.Schraffordt Koops H, Lejeune FJ, Kroon BBR, Klaase JM, Hoekstra HJ. Isolated limb perfusion for melanoma: technical aspects. In: Thompson JF, Morton DL, Kroon BBR, editors. Textbook of melanoma. London: Martin Dunitz; 2004. p. 404–9.Google Scholar
- 19.Lai DTM, Ingvar C, Thompson JF. The value of monitoring serum creatine phosphokinase values following hyperthermic isolated limb perfusion for melanoma. Reg Cancer Treat. 1993;6:36–9.Google Scholar
- 20.World Health Organization. WHO handbook for reporting results of cancer treatments (WHO offset publication no. 48). Geneva: World Health Organization; 1979.Google Scholar
- 30.Jacques DP, Coit DG, Brennan MF. Major amputation for advanced malignant melanoma. Surg Gynecol Obstet. 1989;169:1–6.Google Scholar