Frequency and Duration of Remission After Isolated Limb Perfusion for Melanoma

Thompson, John F.; Hunt, Jeremy; Shannon, Kerwin F.; Kam, P. C. A.

doi:10.1001/archsurg.1997.01430320105017

Cited by 105 publications

(49 citation statements)

References 11 publications

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“…Actinomycin D was used as well as melphalan because of the satisfactory response rates of this combination when administered by conventional ILP in our institution, without excessive toxicity. 2 For the duration of the ILI procedure (20-30 minutes), the infusate was continually circulated by repeated aspiration from the venous catheter and reinjection into the arterial catheter using a syringe attached to a 3-way tap in the external circuit. To increase the limb temperatures, a blood-warming coil was incorporated in the extracorporeal circuit, and the limb was encased by a hot-air blanket, with an overhead radiant heater placed over it.…”

Section: Methodsmentioning

confidence: 99%

“…In these patients, isolated limb perfusion (ILP) with melphalan is a suitable treatment option when other local treatments such as excision, cryotherapy, electrodesiccation, or laser ablation are no longer appropriate because of progressive disease. [1][2][3] Although results after ILP are satisfactory, the technique involves a complex and invasive surgical procedure with a substantial risk of complications. 4,5 Isolated limb infusion (ILI) has been developed at the Sydney Melanoma Unit as a simplified and minimally invasive alternative to ILP.…”

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confidence: 99%

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Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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BACKGROUND:Isolated limb infusion (ILI) is an effective and minimally invasive treatment option for delivering regional chemotherapy in patients with metastatic melanoma confined to a limb. Recurrent or progressive disease after an ILI, however, presents a challenge for further treatment. The value of repeat ILI in this situation has not been well documented.METHODS:Forty‐eight patients were identified who had been treated with a repeat ILI. In all patients, a cytotoxic combination of melphalan and actinomycin D was used.RESULTS:The median time between the 2 procedures was 11 months. The complete response (CR) rate after repeat ILI was 23%, compared with 31% after the initial ILI (P = .36). The overall response was 83%, compared with 75% after the first procedure (P = .32). The median duration of response was 11 months (10 months for patients with CR; P = .80), and median survival was 38 months. In those patients achieving a CR, the median survival was 68 months (P = .003). Toxicity after repeat ILI was increased, with 20 patients experiencing Wieberdink grade III limb toxicity (considerable erythema and edema with blistering) and 5 patients experiencing grade IV toxicity (threatened or actual compartment syndrome), whereas after the initial ILI these toxicity grades occurred in 14 patients and 1 patient, respectively (P = .03). No patient experienced grade V toxicity (requiring amputation).CONCLUSIONS:Repeat ILI is an attractive treatment option to achieve limb salvage in patients with inoperable recurrent or progressive melanoma after a previous ILI. It can be associated with significant short‐term regional toxicity, but is well tolerated by most patients, with satisfactory response rates. Cancer 2009. © 2009 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma

Kroon

Lin

Kam

et al. 2009

Cancer

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“…157,158 Although other agents have been used for ILP, and many have yet to be tested, melphalan (L-phenylalanine mustard) is the cytotoxic agent most commonly used, often in combination with either actinomycin D or TNF-alfa. [158][159][160][161] Response rates after ILP have improved as the method has been refined. A large systematic review (n=2018 ILPs; 22 trials) found that for patients with unresectable stage IIIB-IIIC metastatic melanoma of the limbs, studies published between 1990 and 2008 reported a median overall response rate of 90% (range, 64%-100%) and a median complete response rate of 58% (range, 25%-89%).…”

Section: Regional Therapy: Isolated Limb Perfusion and Infusionmentioning

confidence: 99%

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology

Coit¹,

Thompson²,

Algazi³

et al. 2016

J Natl Compr Canc Netw

218

167

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OverviewIn 2016, an estimated 76,380 patients will be diagnosed with and approximately 10,130 patients will die of melanoma in the United States.1 However, these figures for new cases may represent a substantial underestimate, as many superficial and in situ melanomas treated in the outpatient setting are not reported. The incidence of melanoma continues to increase dramatically, at an overall rate of 33% for men and 23% women from 2002 to 2006.2 Melanoma is increasing in men more rapidly than any other malignancy, and in women more rapidly than any other malignancy except lung cancer. AbstractThis selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and highdose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted reassessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections. J Natl Compr Canc Netw 2016;14(4):450-473 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.All recommendations are category 2A unless otherwise noted.Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines ® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient's care or treatment. The National Comprehensive Cancer Network ® (NCCN ® ) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Melanoma are not printed in this issue of JNCCN but can be accessed online at NCCN.org.© National Comprehensive Cancer Network, Inc. 2016, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN. Disclosures for the NCCN Melanoma ...

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“…It requires simple devices. Since 1992, the Sydney Melanoma Center had performed ILI in over 300 patients in ten years, and its response rate for stage III melanoma was about 80%, during which no treatmentrelated amputation or death was reported (79). The response rate was significantly higher in patients >70 years than in those below 70 years (91 % vs. 78%, P<0.05).…”

Section: Lymph Node Dissectionmentioning

confidence: 99%