Hidde M Kroon1,2, Brendon J Coventry3, Mitchell H Giles3, Michael A Henderson4, David Speakman4, Mark Wall4, Andrew Barbour5, Jonathan Serpell6, Paul Paddle6, Bernard M Smithers5, John F Thompson7,8,9. 1. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. hmkroon@hotmail.com. 2. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. hmkroon@hotmail.com. 3. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. 4. Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia. 5. Queensland Melanoma Project, Discipline of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia. 6. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia. 7. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. 8. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. 9. Department of Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Abstract
BACKGROUND: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. OBJECTIVE: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. METHODS: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20-30 min (±actinomycin D), and toxicity, responses, and survival were recorded. RESULTS: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37% of patients, respectively; p = 0.003). A complete response (CR) was seen in 27% of patients aged ≥75 years and in 38% of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77%, respectively (p = 0.30). No difference in survival was seen (p = 0.69). CONCLUSIONS: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.
BACKGROUND: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. OBJECTIVE: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. METHODS: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20-30 min (±actinomycin D), and toxicity, responses, and survival were recorded. RESULTS: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37% of patients, respectively; p = 0.003). A complete response (CR) was seen in 27% of patients aged ≥75 years and in 38% of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77%, respectively (p = 0.30). No difference in survival was seen (p = 0.69). CONCLUSIONS: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.
Authors: F C Wright; S Kellett; N J Look Hong; A Y Sun; T P Hanna; C Nessim; C A Giacomantonio; C F Temple-Oberle; X Song; T M Petrella Journal: Curr Oncol Date: 2020-06-01 Impact factor: 3.677
Authors: John T Miura; Hidde M Kroon; Georgia M Beasley; Dean Mullen; Norma E Farrow; Paul J Mosca; Michael C Lowe; Clara R Farley; Youngchul Kim; Syeda Mahrukh Hussnain Naqvi; Aishwarya Potdar; Hala Daou; James Sun; Jeffrey M Farma; Michael A Henderson; David Speakman; Jonathan Serpell; Keith A Delman; B Mark Smithers; Brendon J Coventry; Douglas S Tyler; John F Thompson; Jonathan S Zager Journal: Ann Surg Oncol Date: 2019-03-25 Impact factor: 5.344