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Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma
Article first published online: 13 MAR 2009
Copyright © 2009 American Cancer Society
Volume 115, Issue 9, pages 1932–1940, 1 May 2009
How to Cite
Kroon, H. M., Lin, D.-Y., Kam, P. C. A. and Thompson, J. F. (2009), Efficacy of repeat isolated limb infusion with melphalan and actinomycin D for recurrent melanoma. Cancer, 115: 1932–1940. doi: 10.1002/cncr.24220
- Issue published online: 20 APR 2009
- Article first published online: 13 MAR 2009
- Manuscript Accepted: 28 OCT 2008
- Manuscript Revised: 26 OCT 2008
- Manuscript Received: 11 AUG 2008
- Haak Bastiaanse-Kuneman Stichting
- Stichting Fundatie van de Vrijvrouwe van Renswoude te 's-Gravenhage
- Stichting Sacha Swarttouw-Heijmans
- KWF Kankerbestrijding
- Stichting Prof. Michaël-van Vloten Fonds
- Amgen Netherlands BV
- University Medical Center Groningen/Faculty of Medical Sciences of the University of Groningen
- Melanoma Foundation of the University of Sydney
- Melanoma Institute Australia
- metastatic melanoma;
- isolated limb infusion;
- regional chemotherapy;
- limb salvage
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.
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.
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).
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.