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Evaluation of the efficacy and toxicity of upper extremity isolated limb infusion chemotherapy for melanoma: An Australian multi-center study
- Source :
- European Journal of Surgical Oncology. 45:832-837
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
Abstract
- Background Isolated limb infusion (ILI) is a minimally invasive treatment for patients with locally advanced extremity melanoma. Most studies combine results of upper-limb ILI (UL-ILI) and lower-limb ILI (LL-ILI), leaving UL-ILIs relatively underreported as LL-ILIs comprise the vast majority in these reports. However, differences between the two procedures may be clinically important. The aim of this study was to evaluate the efficacy and toxicity of UL-ILI in an Australian multi-center setting. Patients and methods 316 ILI procedures for melanoma performed between 1992 and 2008 in five Australian institutions were analyzed. In all institutions melphalan (±actinomycin D) was circulated in the isolated limb for 20–30 min. Results Baseline patient characteristics for UL-ILI (n = 27) and LL-ILI (n = 289) were similar, except that more men underwent UL-ILI (66% vs. 38%; p = 0.007) and disease in LL-ILI was mostly located on the distal limb (p = 0.02). Median tourniquet times were shorter for UL-ILI (38 vs. 48 min; p = 0.04) and UL-ILI patients experienced less limb toxicity (Grade III/IV in 24% vs. 31%; p = 0.01). Complete response (CR) rates were similar: 33% after LL-ILI (p = 0.70), 30% after UL-ILI, while overall response (OR) rates were higher after LL-ILI: (76%) than UL-ILI (59%; p = 0.05). No difference in survival was seen. Conclusions UL-ILI is safe to perform and effective, resulting in low limb toxicity. CR rates were similar to those for LL-ILI, but OR rates were lower for UL-ILI. It may be possible to improve OR rates achieved by UL-ILI by optimizing perioperative factors, while maintaining low toxicity.
- Subjects :
- Male
Melphalan
medicine.medical_specialty
Skin Neoplasms
medicine.medical_treatment
Upper Extremity
03 medical and health sciences
0302 clinical medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Prospective Studies
030212 general & internal medicine
Antineoplastic Agents, Alkylating
Melanoma
Aged
Aged, 80 and over
Chemotherapy
Tourniquet
Antibiotics, Antineoplastic
business.industry
Australia
virus diseases
General Medicine
Perioperative
Middle Aged
medicine.disease
respiratory tract diseases
Surgery
Oncology
Chemotherapy, Cancer, Regional Perfusion
Lymphatic Metastasis
030220 oncology & carcinogenesis
Multi center study
Toxicity
Dactinomycin
Lymph Node Excision
Female
Isolated limb infusion
business
medicine.drug
Subjects
Details
- ISSN :
- 07487983
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- European Journal of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....70fe906b159d6ee1b06f6cbfe81e6055