John T Miura1, Hidde M Kroon2,3, Georgia M Beasley4, Dean Mullen2, Norma E Farrow4, Paul J Mosca4, Michael C Lowe5, Clara R Farley5, Youngchul Kim1, Syeda Mahrukh Hussnain Naqvi1, Aishwarya Potdar1, Hala Daou1, James Sun1, Jeffrey M Farma6, Michael A Henderson7, David Speakman7, Jonathan Serpell8, Keith A Delman5, B Mark Smithers9, Brendon J Coventry2, Douglas S Tyler10, John F Thompson3,11,12, Jonathan S Zager13,14. 1. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 2. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. 3. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. 4. Department of Surgery, Duke University, Durham, NC, USA. 5. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 6. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. 7. Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia. 8. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia. 9. Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia. 10. Department of Surgery, University Texas Medical Branch, Galveston, TX, USA. 11. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 12. Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia. 13. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Jonathan.Zager@moffitt.org. 14. University of South Florida Morsani School of Medicine, Tampa, USA. Jonathan.Zager@moffitt.org.
Abstract
BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. METHODS: Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). RESULTS: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). CONCLUSION: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.
BACKGROUND: Isolated limb infusion (ILI) is a minimally invasive procedure for delivering high-dose regional chemotherapy to patients with locally advanced or in-transit melanoma located on a limb. The current international multicenter study evaluated the perioperative and long-term oncologic outcomes for patients who underwent ILI for stage 3B or 3C melanoma. METHODS:Patients undergoing a first-time ILI for stage 3B or 3C melanoma (American Joint Committee on Cancer [AJCC] 7th ed) between 1992 and 2018 at five Australian and four United States of America (USA) tertiary referral centers were identified. The primary outcome measures included treatment response, in-field (IPFS) and distant progression-free survival (DPFS), and overall survival (OS). RESULTS: A total of 687 first-time ILIs were performed (stage 3B: n = 383, 56%; stage 3C; n = 304, 44%). Significant limb toxicity (Wieberdink grade 4) developed in 27 patients (3.9%). No amputations (grade 5) were performed. The overall response rate was 64.1% (complete response [CR], 28.9%; partial response [PR], 35.2%). Stable disease (SD) occurred in 14.5% and progressive disease (PD) in 19.8% of the patients. The median follow-up period was 47 months, with a median OS of 38.2 months. When stratified by response, the patients with a CR or PR had a significantly longer median IPFS (21.9 vs 3.0 months; p < 0.0001), DPFS (53.6 vs 12.7 months; p < 0.0001), and OS (46.5 vs 24.4 months; p < 0.0001) than the nonresponders (SD + PD). CONCLUSION: This study is the largest to date reporting long-term outcomes of ILI for locoregionally metastatic melanoma. The findings demonstrate that ILI is effective and safe for patients with stage 3B or 3C melanoma confined to a limb. A favorable response to ILI is associated with significantly longer IFPS, DPFS, and OS.
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Authors: Hidde M Kroon; Brendon J Coventry; Mitchell H Giles; Michael A Henderson; David Speakman; Mark Wall; Andrew Barbour; Jonathan Serpell; Paul Paddle; Alexander G J Coventry; Thomas Sullivan; Bernard Mark Smithers; John F Thompson Journal: Ann Surg Oncol Date: 2015-11-18 Impact factor: 5.344
Authors: Michael J Carr; James Sun; Hidde M Kroon; John T Miura; Georgia M Beasley; Norma E Farrow; Paul J Mosca; Michael C Lowe; Clara R Farley; Youngchul Kim; Syeda Mahrukh Hussnain Naqvi; Dennis A Kirichenko; Aishwarya Potdar; Hala Daou; Dean Mullen; 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: 2020-09-11 Impact factor: 5.344