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Australian Multicenter Study of Isolated Limb Infusion for Melanoma

  • Melanomas
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Isolated limb infusion (ILI) offers a less invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma. In Australia, ILI has essentially completely replaced ILP. The aim of this study was to collect and evaluate the results of ILI in an Australian multicenter setting.

Patients and Methods

The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were collectively analyzed, with all five institutions using the same protocol. Melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D). Response was determined using the World Health Organization criteria, and limb toxicity was assessed using the Wieberdink scale.

Results

The median patient age was 74 years (range 28–100) and 59 % of patients were female. Overall response rate was 75 % (complete response [CR] 33 %; partial response 42 %). Stable disease was seen in 18 % of patients and progressive disease in 7 %. Wieberdink grade III or higher was seen in 30 % of the cases. No toxicity-related amputations occurred, and median survival was 44 months. In patients with a CR, median survival was 80 months (p = 0.014). On multivariate analysis, Breslow thickness, lower-limb ILI, and a procedure performed at the Melanoma Institute Australia remained significant predictors for response, although not for survival.

Conclusions

This Australian multicenter study of ILI is the largest reported to date. ILI is a useful technique that can be safely and effectively performed across tertiary referral centers for the successful management of advanced extremity melanoma. Increased optimization of perioperative factors might allow response rates to be raised further, while maintaining acceptable toxicity.

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Acknowledgments

The authors would like to thank Dr. Nancy Briggs, Senior Statistician, for providing statistical advice, and the Discipline of Public Health of the University of Adelaide, as well as our radiological and anesthetic colleagues for their catheter expertise, generosity, and support. The authors would like to acknowledge the support of John Kelly, Director, Victorian Melanoma Service, Alfred Hospital, Melbourne, and the data managers and research nurses at all institutions.

Disclosure

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Hidde M. Kroon MD, PhD, Brendon J. Coventry BMBS, PhD, FRACS, FACS, FRSM, Mitchell H. Giles BMBS & Alexander G. J. Coventry BMBS

  2. Division of Surgical Oncology, Department of Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia

    Michael A. Henderson MDDS, MD, BMed Sci, David Speakman MDDS, FRACS & Mark Wall BMBS

  3. Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia

    Andrew Barbour MBBS, PhD, FRACS & Bernard Mark Smithers MBBS, FRACS, FRCS

  4. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia

    Jonathan Serpell MDDS, MD, FRACS & Paul Paddle MBBS

  5. Statistics, Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, Adelaide, SA, Australia

    Thomas Sullivan MsC

  6. Melanoma Institute Australia, Sydney, NSW, Australia

    Hidde M. Kroon MD, PhD & John F. Thompson MBBS, BSC(Med), MD, FRACS, FACS

  7. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia

    John F. Thompson MBBS, BSC(Med), MD, FRACS, FACS

  8. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    John F. Thompson MBBS, BSC(Med), MD, FRACS, FACS

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  1. Hidde M. Kroon MD, PhD
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  2. Brendon J. Coventry BMBS, PhD, FRACS, FACS, FRSM
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  3. Mitchell H. Giles BMBS
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  10. Alexander G. J. Coventry BMBS
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  11. Thomas Sullivan MsC
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  12. Bernard Mark Smithers MBBS, FRACS, FRCS
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  13. John F. Thompson MBBS, BSC(Med), MD, FRACS, FACS
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Corresponding authors

Correspondence to Hidde M. Kroon MD, PhD or Brendon J. Coventry BMBS, PhD, FRACS, FACS, FRSM.

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Kroon, H.M., Coventry, B.J., Giles, M.H. et al. Australian Multicenter Study of Isolated Limb Infusion for Melanoma. Ann Surg Oncol 23, 1096–1103 (2016). https://doi.org/10.1245/s10434-015-4969-2

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