Does Increased Experience with Isolated Limb Infusion for Advanced Limb Melanoma Influence Outcome? A Comparison of Two Treatment Periods at a Single Institution

Huismans, Anna M.; Kroon, Hidde M.; Kam, P. C. A.; Thompson, John F.

doi:10.1245/s10434-011-1646-y

Cited by 27 publications

(17 citation statements)

References 24 publications

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“…Twenty percent of the ILI cohort also developed ≥ Grade 3 Wieberdink toxicity, whereas ILP was associated with a 27% risk of ≥ Grade 3 toxicity <25>. The Sydney Melanoma Unit recently reported a 0% limb loss rate with ILI for melanoma, but observed a 35% rate of ≥ Grade 3 toxicity <26>. Santillan et al found toxicity after ILI to be associated with female sex, papaverine, and high peak CK levels.…”

Section: Discussionmentioning

confidence: 99%

Isolated Limb Infusion in a Series of Over 100 Infusions: A Single-Center Experience

et al. 2013

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Introduction Isolated limb infusion (ILI) is a therapeutic option for patients with recurrent, unresectable extremity malignancies. Methods A prospectively collected single institution database of patients undergoing ILI was analyzed for preoperative, intraoperative, and postoperative parameters and outcomes. Results From 5/2007-1/2012, 76 patients successfully underwent initial ILI, and 28 following either previous hyperthermic isolated limb perfusion (HILP) or ILI. Seventy-nine (74%) patients had melanoma, 24 (22%) sarcoma, 3 (3%) Merkel cell and 1 (1%) squamous cell carcinoma. There were 55 (72%) initial and 22 (79%) repeat lower extremity (LE) ILI’s, and 21 (78%) initial and 6 (22%) repeat upper extremity (UE) ILI’s. Serologic toxicity, measured by serum creatine kinase (CK), peaked higher and later in LE ILI’s, median 620 vs. 124 IU/L and postoperative day 4 vs. 2, respectively, P<0.05. LE ILI’s had a longer hospital length of stay (LOS), median 6 vs. 5 days (P<0.0001). A median of grade II Wieberdink regional toxicity was observed. Three-month follow-up was available in 94 (90%). A response (ORR) was seen in 72% of ILI’s performed for melanoma and 58% for sarcoma. No difference in response was observed between UE vs. LE or between initial vs. repeat ILI’s. Repeat UE ILI’s, however, appeared to have an improved ORR than repeat LE ILI’s, 83% vs. 64%. Conclusion ILI may be successfully performed for cutaneous and soft tissue malignancies. LE ILI’s have higher CK levels and slightly longer LOS. Repeat ILI’s are not associated with increased toxicity and similar ORR. UE ILI’s may have better overall response rates.

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Section: Discussionmentioning

confidence: 99%

Isolated Limb Infusion in a Series of Over 100 Infusions: A Single-Center Experience

et al. 2013

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“…Other treatments may include isolated limb infusion (ILI) or intralesional injection with substances such as interleukin-2 [18,19] and other agents [20]. ILI is less invasive, allows for shorter surgery and perfusion times and uses lower temperatures and might be an option for patients in otherwise limited medical and cardiac condition.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

et al. 2013

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BackgroundHyperthermic isolated limb perfusion (HILP) is used for patients with intractable or extensive in-transit metastatic melanoma of the limb to deliver high concentrations of cytotoxic agents to the affected limb and offers a treatment option in a disease stage with a poor prognosis when no treatment is given.MethodsIn a retrospective chart review of 17 cases, we studied the anesthetic and hemodynamic changes during HILP and its management.ResultsHILP was well tolerated except in one case that is described herein. We present summary data of all cases undergoing upper and lower limb perfusion, discuss our current clinical practice of preoperative, perioperative and intraoperative patient care including the management of HILP circuit.ConclusionHILP is a challenging procedure, and requires a team effort including the surgical team, anesthesia care providers, perfusionists and nurses. Intraoperatively, invasive hemodynamic and metabolic monitoring is indispensable to manage significant hemodynamic and metabolic changes due to fluid shifts and release of cytokines.

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“…They concluded that ILI produced outcomes and duration of response comparable to HILP(15). A recently updated publication by the MIA showed a slightly decreased ORR of 77% for their more recent ILIs; however, no significant survival differences were observed (16). …”

Section: Discussionmentioning

confidence: 99%

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

et al. 2013

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Introduction Isolated limb infusion (ILI) is a limb-preserving treatment for in-transit extremity melanoma. The benefit of resecting residual disease following ILI is unclear. Methods A multi-institutional experience was analyzed comparing patients who underwent ILI plus resection of residual disease (ILI+RES) versus ILI-alone. Results 176 patients were included: 154 ILI-alone and 22 ILI+RES. There were no differences between the groups with respect to gender, age, extremity affected, or time from diagnosis to ILI. All surgical resections were performed as an outpatient procedure, separate from the ILI. Within the ILI+RES group, fifteen (68%) had a partial response (PR), two (9%) stable disease (SD), and 5 (23%) progressive disease (PD). The ILI-alone group had 52 (34%) CR, 30 (19%) PR, 15 (10%) SD, and 46 (30%) PD. Eleven (7%) ILI-alone patients did not have 3-month response available for review. Evaluating overall survival (OS) from date of ILI, the ILI-alone group had a median OS of 30.9 months, whereas the ILI+RES group had not reached median OS, p=0.304. Although the ILI+RES group had a slightly longer disease free survival (DFS) compared to those with a CR after ILI-alone (12.4 vs. 9.6), this was not statistically significant, p=0.978. Within the ILI+RES group, those with an initial PR following ILI had improved DFS vs. those with SD or PD following ILI, p<0.0001. Conclusion Resection of residual disease following ILI offers a DFS and OS similar to those who have a CR after ILI-alone, and may offer a treatment strategy that benefits more patients undergoing ILI.

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Does Increased Experience with Isolated Limb Infusion for Advanced Limb Melanoma Influence Outcome? A Comparison of Two Treatment Periods at a Single Institution

Cited by 27 publications

References 24 publications

Isolated Limb Infusion in a Series of Over 100 Infusions: A Single-Center Experience

Isolated Limb Infusion in a Series of Over 100 Infusions: A Single-Center Experience

Anesthesia management of patients undergoing hyperthermic isolated limb perfusion with melphalan for melanoma treatment: an analysis of 17 cases

Resection of Residual Disease after Isolated Limb Infusion (ILI) Is Equivalent to a Complete Response after ILI-Alone in Advanced Extremity Melanoma

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