Jüri Teras1,2,3, Hidde M Kroon4,5, John T Miura6,7, Tim Kenyon-Smith1, Georgia M Beasley8, Dean Mullen1, Norma E Farrow8, Paul J Mosca8, Michael C Lowe9, Clara R Farley9, Aishwarya Potdar6, Hala Daou6, James Sun6, Michael Carr6, Jeffrey M Farma10, Michael A Henderson11, David Speakman11, Jonathan Serpell12, Keith A Delman9, B Mark Smithers13, Andrew Barbour13, Douglas S Tyler14, Brendon J Coventry1, Jonathan S Zager6, John F Thompson15,16,17. 1. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. 2. Department of Surgical Oncology, North Estonian Medical Centre Foundation, Tallinn, Estonia. 3. Tallinn University of Technology, Tallinn, Estonia. 4. Department of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia. hidde.kroon@sa.gov.au. 5. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. hidde.kroon@sa.gov.au. 6. Department of Cutaneous Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 7. Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. 8. Department of Surgery, Duke University, Durham, NC, USA. 9. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 10. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. 11. Division of Surgical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia. 12. Discipline of Surgery, The Alfred Hospital, Melbourne, VIC, Australia. 13. Queensland Melanoma Project, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia. 14. Department of Surgery, University Texas Medical Branch, Galveston, TX, USA. 15. Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. 16. Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 17. Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Abstract
BACKGROUND: Isolated limb infusion (ILI) is used to treat in-transit melanoma metastases confined to an extremity. However, little is known about its safety and efficacy in octogenarians and nonagenarians (ON). PATIENTS AND METHODS: ON patients (≥ 80 years) who underwent a first ILI for American Joint Committee on Cancer seventh edition stage IIIB/IIIC melanoma between 1992 and 2018 at nine international centers were included and compared with younger patients (< 80 years). A cytotoxic drug combination of melphalan and actinomycin-D was used. RESULTS: Of the 687 patients undergoing a first ILI, 160 were ON patients (median age 84 years; range 80-100 years). Compared with the younger cohort (n = 527; median age 67 years; range 29-79 years), ON patients were more frequently female (70.0% vs. 56.9%; p = 0.003), had more stage IIIB disease (63.8 vs. 53.3%; p = 0.02), and underwent more upper limb ILIs (16.9% vs. 9.5%; p = 0.009). ON patients experienced similar Wieberdink limb toxicity grades III/IV (25.0% vs. 29.2%; p = 0.45). No toxicity-related limb amputations were performed. Overall response for ON patients was 67.3%, versus 64.6% for younger patients (p = 0.53). Median in-field progression-free survival was 9 months for both groups (p = 0.88). Median distant progression-free survival was 36 versus 23 months (p = 0.16), overall survival was 29 versus 40 months (p < 0.0001), and melanoma-specific survival was 46 versus 78 months (p = 0.0007) for ON patients compared with younger patients, respectively. CONCLUSIONS: ILI in ON patients is safe and effective with similar response and regional control rates compared with younger patients. However, overall and melanoma-specific survival are shorter.
BACKGROUND: Isolated limb infusion (ILI) is used to treat in-transit melanoma metastases confined to an extremity. However, little is known about its safety and efficacy in octogenarians and nonagenarians (ON). PATIENTS AND METHODS: ON patients (≥ 80 years) who underwent a first ILI for American Joint Committee on Cancer seventh edition stage IIIB/IIIC melanoma between 1992 and 2018 at nine international centers were included and compared with younger patients (< 80 years). A cytotoxic drug combination of melphalan and actinomycin-D was used. RESULTS: Of the 687 patients undergoing a first ILI, 160 were ON patients (median age 84 years; range 80-100 years). Compared with the younger cohort (n = 527; median age 67 years; range 29-79 years), ON patients were more frequently female (70.0% vs. 56.9%; p = 0.003), had more stage IIIB disease (63.8 vs. 53.3%; p = 0.02), and underwent more upper limb ILIs (16.9% vs. 9.5%; p = 0.009). ON patients experienced similar Wieberdink limb toxicity grades III/IV (25.0% vs. 29.2%; p = 0.45). No toxicity-related limb amputations were performed. Overall response for ON patients was 67.3%, versus 64.6% for younger patients (p = 0.53). Median in-field progression-free survival was 9 months for both groups (p = 0.88). Median distant progression-free survival was 36 versus 23 months (p = 0.16), overall survival was 29 versus 40 months (p < 0.0001), and melanoma-specific survival was 46 versus 78 months (p = 0.0007) for ON patients compared with younger patients, respectively. CONCLUSIONS: ILI in ON patients is safe and effective with similar response and regional control rates compared with younger patients. However, overall and melanoma-specific survival are shorter.
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