Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma

Brendon J. Coventry, Hidde M. Kroon, Mitchell H. Giles, Michael Henderson, David Speakman, Mark Wall, Andrew Barbour, Jonathan Serpell, Paul Paddle, Alexander G J Coventry, Thomas Sullivan, B. Mark Smithers

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia). Methods Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63% (CR 27%; PR 36%). Wieberdink toxicity grade III or higher was seen in 13%. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P-=-0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response. Conclusion In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.
Original languageEnglish
Pages (from-to)780-785
Number of pages6
JournalJournal of Surgical Oncology
Volume109
Issue number8
DOIs
Publication statusPublished - 2014
Externally publishedYes

Keywords

  • chemotherapy
  • isolated limb infusion
  • metastatic melanoma

Cite this

Coventry, B. J., Kroon, H. M., Giles, M. H., Henderson, M., Speakman, D., Wall, M., ... Smithers, B. M. (2014). Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma. Journal of Surgical Oncology, 109(8), 780-785. https://doi.org/10.1002/jso.23590
Coventry, Brendon J. ; Kroon, Hidde M. ; Giles, Mitchell H. ; Henderson, Michael ; Speakman, David ; Wall, Mark ; Barbour, Andrew ; Serpell, Jonathan ; Paddle, Paul ; Coventry, Alexander G J ; Sullivan, Thomas ; Smithers, B. Mark. / Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma. In: Journal of Surgical Oncology. 2014 ; Vol. 109, No. 8. pp. 780-785.
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title = "Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma",
abstract = "Introduction Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia). Methods Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63{\%} (CR 27{\%}; PR 36{\%}). Wieberdink toxicity grade III or higher was seen in 13{\%}. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P-=-0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response. Conclusion In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.",
keywords = "chemotherapy, isolated limb infusion, metastatic melanoma",
author = "Coventry, {Brendon J.} and Kroon, {Hidde M.} and Giles, {Mitchell H.} and Michael Henderson and David Speakman and Mark Wall and Andrew Barbour and Jonathan Serpell and Paul Paddle and Coventry, {Alexander G J} and Thomas Sullivan and Smithers, {B. Mark}",
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Coventry, BJ, Kroon, HM, Giles, MH, Henderson, M, Speakman, D, Wall, M, Barbour, A, Serpell, J, Paddle, P, Coventry, AGJ, Sullivan, T & Smithers, BM 2014, 'Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma' Journal of Surgical Oncology, vol. 109, no. 8, pp. 780-785. https://doi.org/10.1002/jso.23590

Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma. / Coventry, Brendon J.; Kroon, Hidde M.; Giles, Mitchell H.; Henderson, Michael; Speakman, David; Wall, Mark; Barbour, Andrew; Serpell, Jonathan; Paddle, Paul; Coventry, Alexander G J; Sullivan, Thomas; Smithers, B. Mark.

In: Journal of Surgical Oncology, Vol. 109, No. 8, 2014, p. 780-785.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Australian multi-center experience outside of the Sydney Melanoma Unit of isolated limb infusion chemotherapy for melanoma

AU - Coventry, Brendon J.

AU - Kroon, Hidde M.

AU - Giles, Mitchell H.

AU - Henderson, Michael

AU - Speakman, David

AU - Wall, Mark

AU - Barbour, Andrew

AU - Serpell, Jonathan

AU - Paddle, Paul

AU - Coventry, Alexander G J

AU - Sullivan, Thomas

AU - Smithers, B. Mark

PY - 2014

Y1 - 2014

N2 - Introduction Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia). Methods Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63% (CR 27%; PR 36%). Wieberdink toxicity grade III or higher was seen in 13%. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P-=-0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response. Conclusion In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.

AB - Introduction Isolated limb infusion (ILI) is a minimally invasive alternative to isolated limb perfusion (ILP) for delivering high-dose regional chemotherapy to treat locally advanced limb melanoma. The current study aimed to evaluate the applicability of ILI in four Australian tertiary referral centers outside of its originating institution, the Sydney Melanoma Unit (SMU; currently known as the Melanoma Institute Australia). Methods Data of 131 patients, treated between 1992 and 2008 were collectively analyzed. The ILI procedures were based on the Sydney Melanoma Unit protocol using melphalan. Response was determined using the WHO criteria and toxicity was assessed using the Wieberdink scale. Results The median patient age was 74 years (range 28-100). Fifty-six percent were female. Overall response (OR) rate to ILI was 63% (CR 27%; PR 36%). Wieberdink toxicity grade III or higher was seen in 13%. No toxicity-related amputations occurred. Median follow-up was 24 months; median survival was 58 months. In patients with a complete response (CR), median survival was 101 months; in patients with a partial response (PR) this was 41 months (P-=-0.026). On univariate analysis a younger age, lower-limb procedures and a lower Breslow thickness of the primary melanoma were associated with a favorable response. On multivariate analysis Breslow thickness and lower-limb ILI remained significant predictors for response. Conclusion In this, to date, largest multi-center study of ILI for melanoma the results are comparable to other reports and demonstrate that ILI can be widely implemented and safely applied across tertiary referral centers.

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