Isolated limb infusion chemotherapy for melanoma: an overview of early experience at the Adelaide Melanoma Unit

Abstract

Background

Isolated limb infusion (ILI) using cytotoxic agents has been demonstrated to be an effective and less invasive alternative modality than isolated limb perfusion for the treatment of melanoma localized to a limb. Percutaneous catheters were inserted into the axial artery and vein of the affected limb while using a pneumatic cuff to restrict limb vascular flow proximally to “isolate” the limb from the body and enable delivery of high-dose intra-arterial chemotherapy selectively to the limb. The ILI technique was developed at the Sydney Melanoma Unit (now renamed the Melanoma Institute Australia), and only a few other centers have reported separate results. We report our early results using the ILI technique for management of locally recurrent surgically nonresectable melanoma.

Methods and results

Twenty-eight ILI procedures were performed in 20 patients treated with one or more procedures between 1997 and 2007. Patient parameters and clinical responses were evaluated. The median follow-up duration was 15.9 months after the first ILI, with an overall response rate after one or more infusions of 70%, of which 35% were complete responders and 35% were partial responders, with a further 20% showing stable disease, giving a “clinically significant” response rate of 90%. After one ILI (n = 20), the overall response rate was 70%, with 20% complete responders and 50% partial responders, and 20% with stable disease. Low limb toxicities were generally observed, and no amputations were required.

Conclusion

ILI chemotherapy is a useful technique, which can be readily repeated for control of melanoma in the limb. It is generally well tolerated, and is capable of achieving a cure, delayed progression, or effective palliation in selected cases. The longest survivors in this series were 8 and 10 years from the last ILI.

Keywords:

• metastatic melanoma
• melphalan
• actinomycin-D
• regional therapy
• intra-arterial infusion

Acknowledgments

The authors wish to thank Professor John F Thompson, Sydney Melanoma Unit, Royal Prince Alfred Hospital, Sydney, for his guidance and advice in the early stages of establishment of ILI therapy, and Dr R Waugh, Radiology Department, Royal Prince Alfred Hospital, for his advice regarding catheter selection and technique. Thanks are also extended to Dr G Freer for his anesthetic expertise in pioneering the ILI procedure at our institution. Additional thanks for statistical support go to Nancy Briggs and Tom Sullivan of the Department of Public Health, The University of Adelaide, and to our radiological colleagues at the Royal Adelaide Hospital for their catheter expertise. We thank Hidde Kroon (The Netherlands) for reviewing the manuscript.

Disclosure

The authors report no conflicts of interest in this work.