BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation. METHODS: From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20-30 min under mild hyperthermic conditions (38-39 degrees C). RESULTS: The majority of patients (62%) were female. Their average age was 74 years (range 29-93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable outcome were achievement of CR, stage of disease, thickness of primary melanoma, the CO(2 )level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema). CONCLUSION: The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.
BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive technique for delivering regional chemotherapy in patients with advanced and metastatic melanoma confined to a limb. It is essentially a low-flow isolated limb perfusion (ILP) performed via percutaneous catheters without oxygenation. METHODS: From our prospective database 185 patients with advanced metastatic melanoma of the limb treated with a single ILI between 1993 and 2007 were identified. In all patients a cytotoxic drug combination of melphalan and actinomycin-D was used. Drug circulation time was 20-30 min under mild hyperthermic conditions (38-39 degrees C). RESULTS: The majority of patients (62%) were female. Their average age was 74 years (range 29-93 years). Most patients had MD Anderson stage III disease (134/185). The overall response rate was 84% [complete response (CR) rate 38%, partial response rate 46%]. Median response duration was 13 months (22 months for patients with CR; P = 0.01). Median follow-up was 20 months and median survival was 38 months. In those patients with a CR, the median survival was 53 months (P = 0.005). CR rate and survival time decreased with increasing stage of disease. On multivariate analysis significant factors for a favorable outcome were achievement of CR, stage of disease, thickness of primary melanoma, the CO(2 )level in the isolated circuit, and a Wieberdink limb toxicity score of III (considerable erythema and edema). CONCLUSION: The response rates and duration of response after ILI are comparable to those achieved by conventional ILP. ILI is a minimally invasive alternative to the much more complex and morbid conventional ILP technique for patients with advanced metastatic melanoma confined to a limb.
Authors: Christy Y Chai; Jeremiah L Deneve; Georgia M Beasley; Suroosh S Marzban; Y Ann Chen; Bhupendra Rawal; Stephen R Grobmyer; Steven N Hochwald; Douglas S Tyler; Jonathan S Zager Journal: Ann Surg Oncol Date: 2011-12-06 Impact factor: 5.344
Authors: Amanda K Raymond; Georgia M Beasley; Gloria Broadwater; Christina K Augustine; James C Padussis; Ryan Turley; Bercedis Peterson; Hilliard Seigler; Scott K Pruitt; Douglas S Tyler Journal: J Am Coll Surg Date: 2011-04-13 Impact factor: 6.113
Authors: Georgia M Beasley; Paul Speicher; Ketan Sharma; Hilliard Seigler; April Salama; Paul Mosca; Douglas S Tyler Journal: J Am Coll Surg Date: 2013-12-24 Impact factor: 6.113
Authors: Gina Shetty; Georgia M Beasley; Sara Sparks; Michael Barfield; Melanie Masoud; Paul J Mosca; Scott K Pruitt; April K S Salama; Cliburn Chan; Douglas S Tyler; Kent J Weinhold Journal: Ann Surg Oncol Date: 2013-03-02 Impact factor: 5.344
Authors: N McMahon; T Y Cheng; G M Beasley; I Spasojevic; W Petros; C K Augustine; P Zipfel; J C Padussis; G Sanders; Douglas S Tyler Journal: Ann Surg Oncol Date: 2009-01-30 Impact factor: 5.344