Annals of Surgical Oncology

, Volume 21, Issue 2, pp 650–655 | Cite as

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

  • Joyce Wong
  • Y. Ann Chen
  • Kate J. Fisher
  • Georgia M. Beasley
  • Douglas S. Tyler
  • Jonathan S. Zager



Isolated limb infusion (ILI) is a limb-preserving treatment for in-transit extremity melanoma. The benefit of resecting residual disease after ILI is unclear.


A multi-institutional experience was analyzed comparing patients who underwent ILI plus resection of residual disease (ILI + RES) versus ILI-alone.


A total of 176 patients were included, 154 with ILI-alone and 22 with 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, 15 (68 %) had a partial response (PR), 2 (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 after ILI had improved DFS versus those with SD or PD after ILI, p < 0.0001.


Resection of residual disease after ILI offers a DFS and OS similar to those who have a CR after ILI-alone. It may offer a treatment strategy that benefits patients undergoing ILI.


Overall Survival Median Overall Survival Overall Response Rate Isolate Limb Perfusion Isolate Limb Infusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


  1. 1.
    American Cancer Society. Cancer facts and figures. 2012. Atlanta: American Cancer Society; 2012.Google Scholar
  2. 2.
    Melanoma of the skin. In: Edge SB, Byrd DR, Compton CC, et al., eds. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. p. 325–44.Google Scholar
  3. 3.
    Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27:6199–206.PubMedCrossRefGoogle Scholar
  4. 4.
    Romano E, Scordo M, Dusza SW, et al. Site and timing of first relapse in stage III melanoma patients: implications for follow-up guidelines. J Clin Oncol. 2010;28:3042–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Thompson JF, Kam PC, Waugh RC, Harman CR. Isolated limb infusion with cytotoxic agents: a simple alternative to isolated limb perfusion. Semin Surg Oncol. 1998;14:238–47.PubMedCrossRefGoogle Scholar
  6. 6.
    Kroon HM, Lin DY, Kam PC, Thompson JF. Isolated limb infusion as palliative treatment for advanced limb disease in patients with AJCC stage IV melanoma. Ann Surg Oncol. 2009;16:1193–201.PubMedCrossRefGoogle Scholar
  7. 7.
    McClaine RJ, Giglia JS, Ahmad SA, et al. Quality of life outcomes after isolated limb infusion. Ann Surg Oncol. 2012;19:1372–8.CrossRefGoogle Scholar
  8. 8.
    Barbour AP, Thomas J, Suffolk J, et al. Isolated limb infusion for malignant melanoma: predictors of response and outcome. Ann Surg Oncol. 2009;16:3463–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Alexander HR Jr, Fraker DL, Bartlett DL, et al. Analysis of factors influencing outcome in patients with in-transit malignant melanoma undergoing isolated limb perfusion using modern treatment paramenters. J Clin Oncol. 2010;28:114–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Boesch CE, Meyer T, Washcke L, et al. Long-term outcome of hyperthermic isolated limb perfusion (HILP) in the treatment of locoregionally metastasized malignant melanoma of the extremities. Int J Hyperthermia. 2010;26:16–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Raymond AK, Beasley GM, Broadwater G, et al. Current trends in regional therapy for melanoma: lessons learned from 225 regional chemotherapy treatments between 1995 and 2010 at a single institution. J Am Coll Surg. 2011;213:306–16.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Beasley GM, Petersen RP, Yoo J, et al. Isolated limb infusion for in-transit malignant melanoma of the extremity: a well-tolerated but less effective alternative to hyperthermic isolated limb perfusion. Ann Surg Oncol. 2008;15:2195–205.PubMedCrossRefGoogle Scholar
  13. 13.
    Santillan AA, Zager JS. Isolated limb infusion for melanoma: a less morbid alternative to hyperthermic isolated limb perfusion in the US. Expert Opin Drug Metab Toxicol. 2010;6:1033–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Beasley GM, Sharma K, Wong J, et al. A multi-institution experience comparing the clinical and physiologic differences between upper extremity and lower extremity melphalan-based isolated limb infusion. Cancer. 2012;118:6136–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Kroon HM, Moncrieff M, Kam PCA, Thompson JF. Outcomes following isolated limb infusion for melanoma: a 14-year experience. Ann Surg Oncol. 2008;15:3003–13.PubMedCrossRefGoogle Scholar
  16. 16.
    Huismans AM, Kroon HM, Kam PCA, Thompson JF. Does increased experience with isolated limb infusion for advanced limb melanoma influence outcome? A comparision of two treatment periods at a single institution. Ann Surg Oncol. 2011;18:1877–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Beasley GM, Caudle A, Petersen RP, et al. A multi-institutional experience of isolated limb infusion: defining response and toxicity in the US. J Am Coll Surg. 2009;208:106–15.CrossRefGoogle Scholar
  18. 18.
    Santillan AA, Delman KA, Beasley GM, et al. Predictive factors of regional toxicity and serum creatine phosphokinase levels after isolated limb infusion for melanoma: a multi-institutional analysis. Ann Surg Oncol. 2009;16:2570–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Sharma K, Beasley G, Turley R, et al. Patterns of recurrence following complete response to regional chemotherapy for in-transit melanoma. Ann Surg Oncol. 2012;19:2563–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Kroon HM, Lin DY, Kam PCA, Thompson JF. Major amputation for irresectable extremity melanoma after failure of isolated limb infusion. Ann Surg Oncol. 2009;16:1543–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Chai CY, Deneve JL, Beasley GM, et al. A multi-institutional experience of repeat regional chemotherapy for recurrent melanoma of the extremities. Ann Surg Oncol. 2012;19:1637–43.PubMedCrossRefGoogle Scholar
  22. 22.
    Testori A, Intellisano A, Verrecchia F, et al. Alternatives for the treatment of local advanced disease: electrochemotherapy, limb perfusion, limb infusion, intralesional IL2. What is the role? Dermatol Ther. 2012;25:443–51.PubMedCrossRefGoogle Scholar
  23. 23.
    Testori A, Faries MB, Thompson JF, et al. Local and intralesional therapy of in-transit melanoma metastases. J Surg Oncol. 2011;104:391–6.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Joyce Wong
    • 1
    • 2
  • Y. Ann Chen
    • 3
  • Kate J. Fisher
    • 3
  • Georgia M. Beasley
    • 4
  • Douglas S. Tyler
    • 4
  • Jonathan S. Zager
    • 1
    • 2
  1. 1.Department of Cutaneous OncologyMoffitt Cancer CenterTampaUSA
  2. 2.Department of Surgery at the University of South FloridaMorsani School of MedicineTampaUSA
  3. 3.Department of Bioinformatics and StatisticsMoffitt Cancer CenterTampaUSA
  4. 4.Department of SurgeryDuke University Medical CenterDurhamUSA

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