BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. STUDY DESIGN: Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42% (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. RESULTS: In 128 evaluable patients, complete response rate was 31%, partial response rate was 33%, and there was no response in 36% of patients. For all patients (n = 162), 36% had Wieberdink toxicity grade >or=3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade >or=3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). CONCLUSIONS: In the first multi-institutional analysis of ILI, a complete response rate of 31% was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.
BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive approach for treating in-transit extremity melanoma, with only two US single-center studies reported. Establishing response and toxicity to ILI as compared with hyperthermic isolated limb perfusion is important for optimizing future regional chemotherapeutic strategies in melanoma. STUDY DESIGN:Patient characteristics and procedural variables were collected retrospectively from 162 ILIs performed at 8 institutions (2001 to 2008) and compared using chi-square and Student's t-test. ILIs were performed for 30 minutes in patients with in-transit melanoma. Melphalan dose was corrected for ideal body weight (IBW) in 42% (n = 68) of procedures. Response was determined at 3 months by Response Evaluation Criteria in Solid Tumors; toxicity was assessed using the Wieberdink Limb Toxicity Scale. RESULTS: In 128 evaluable patients, complete response rate was 31%, partial response rate was 33%, and there was no response in 36% of patients. For all patients (n = 162), 36% had Wieberdink toxicity grade >or=3 with one toxicity-related amputation. On multivariate analysis, smaller limb volumes were associated with better overall response (p = 0.021). Use of papaverine in the circuit to achieve cutaneous vasodilation was associated with better response (p < 0.001) but higher risk of grade >or=3 toxicity (p = 0.001). Correction of melphalan dose for ideal body weight did not alter complete response (p = 0.345), but did lead to marked reduction in toxicity (p < 0.001). CONCLUSIONS: In the first multi-institutional analysis of ILI, a complete response rate of 31% was achieved with acceptable toxicity demonstrating this procedure to be a reasonable alternative to hyperthermic isolated limb perfusion in the management of advanced extremity melanoma.
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: Jerry R Mendell; Louis G Chicoine; Samiah A Al-Zaidy; Zarife Sahenk; Kelly Lehman; Linda Lowes; Natalie Miller; Lindsay Alfano; Beverly Galliers; Sarah Lewis; Darren Murrey; Ellyn Peterson; Danielle A Griffin; Kathleen Church; Sharon Cheatham; John Cheatham; Mark J Hogan; Louise R Rodino-Klapac Journal: Hum Gene Ther Date: 2019-04-19 Impact factor: 5.695
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