Safety and Efficacy of Isolated Limb Infusion Chemotherapy for Advanced Locoregional Melanoma in Elderly Patients: An Australian Multicenter Study

Hidde M. Kroon, Brendon J. Coventry, Mitchell H. Giles, Michael A. Henderson, David Speakman, Mark Wall, Andrew Barbour, Jonathan Serpell, Paul Paddle, Bernard M. Smithers, John F. Thompson

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. Objective: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. Methods: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D), and toxicity, responses, and survival were recorded. Results: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37% of patients, respectively; p = 0.003). A complete response (CR) was seen in 27% of patients aged ≥75 years and in 38% of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77%, respectively (p = 0.30). No difference in survival was seen (p = 0.69). Conclusions: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.

Original languageEnglish
Pages (from-to)3245-3251
Number of pages7
JournalAnnals of Surgical Oncology
Volume24
Issue number11
DOIs
Publication statusPublished - 1 Oct 2017
Externally publishedYes

Cite this

Kroon, Hidde M. ; Coventry, Brendon J. ; Giles, Mitchell H. ; Henderson, Michael A. ; Speakman, David ; Wall, Mark ; Barbour, Andrew ; Serpell, Jonathan ; Paddle, Paul ; Smithers, Bernard M. ; Thompson, John F. / Safety and Efficacy of Isolated Limb Infusion Chemotherapy for Advanced Locoregional Melanoma in Elderly Patients : An Australian Multicenter Study. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 11. pp. 3245-3251.
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title = "Safety and Efficacy of Isolated Limb Infusion Chemotherapy for Advanced Locoregional Melanoma in Elderly Patients: An Australian Multicenter Study",
abstract = "Background: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. Objective: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. Methods: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D), and toxicity, responses, and survival were recorded. Results: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37{\%} of patients, respectively; p = 0.003). A complete response (CR) was seen in 27{\%} of patients aged ≥75 years and in 38{\%} of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77{\%}, respectively (p = 0.30). No difference in survival was seen (p = 0.69). Conclusions: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.",
author = "Kroon, {Hidde M.} and Coventry, {Brendon J.} and Giles, {Mitchell H.} and Henderson, {Michael A.} and David Speakman and Mark Wall and Andrew Barbour and Jonathan Serpell and Paul Paddle and Smithers, {Bernard M.} and Thompson, {John F.}",
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Safety and Efficacy of Isolated Limb Infusion Chemotherapy for Advanced Locoregional Melanoma in Elderly Patients : An Australian Multicenter Study. / Kroon, Hidde M.; Coventry, Brendon J.; Giles, Mitchell H.; Henderson, Michael A.; Speakman, David; Wall, Mark; Barbour, Andrew; Serpell, Jonathan; Paddle, Paul; Smithers, Bernard M.; Thompson, John F.

In: Annals of Surgical Oncology, Vol. 24, No. 11, 01.10.2017, p. 3245-3251.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Safety and Efficacy of Isolated Limb Infusion Chemotherapy for Advanced Locoregional Melanoma in Elderly Patients

T2 - An Australian Multicenter Study

AU - Kroon, Hidde M.

AU - Coventry, Brendon J.

AU - Giles, Mitchell H.

AU - Henderson, Michael A.

AU - Speakman, David

AU - Wall, Mark

AU - Barbour, Andrew

AU - Serpell, Jonathan

AU - Paddle, Paul

AU - Smithers, Bernard M.

AU - Thompson, John F.

PY - 2017/10/1

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N2 - Background: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. Objective: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. Methods: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D), and toxicity, responses, and survival were recorded. Results: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37% of patients, respectively; p = 0.003). A complete response (CR) was seen in 27% of patients aged ≥75 years and in 38% of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77%, respectively (p = 0.30). No difference in survival was seen (p = 0.69). Conclusions: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.

AB - Background: Isolated limb infusion (ILI) offers a minimally invasive treatment option for locally advanced extremity melanoma. Objective: The aim of the current study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. Methods: The results of 316 first ILI procedures, performed between 1992 and 2008 in five Australian institutions, were identified and analyzed, with the main focus on elderly patients (≥75 years of age). All institutions used the same protocol: melphalan was circulated in the isolated limb for 20–30 min (±actinomycin D), and toxicity, responses, and survival were recorded. Results: Characteristics of patients aged ≥75 years (n = 148) were similar to those aged <75 years (n = 168), except that older patients had more melanoma deposits (median 4 vs. 5; p = 0.035) and lower limb volumes (5.4 vs. 6.5 L; p = 0.001). Median drug circulation times were lower in the older group (21 vs. 24 min; p = 0.04), and older patients experienced less limb toxicity (grade III/IV in 22 and 37% of patients, respectively; p = 0.003). A complete response (CR) was seen in 27% of patients aged ≥75 years and in 38% of patients aged <75 years (p = 0.06), while overall response rates were 72 and 77%, respectively (p = 0.30). No difference in survival was seen (p = 0.69). Conclusions: The ILI technique proved safe and effective in elderly patients. When present, toxicity was localized, and lower compared with younger patients, possibly due to shorter drug circulation times. CR rates were higher in younger patients, although not significantly, while overall response and survival were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity.

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