International Multicenter Experience of Isolated Limb Infusion for In-Transit Melanoma Metastases in Octogenarian and Nonagenarian Patients

• Published in: Annals of surgical oncology Vol. 27; no. 5; pp. 1420 - 1429
• Main Authors: Teras, Jüri, Kroon, Hidde M., Miura, John T., Kenyon-Smith, Tim, Beasley, Georgia M., Mullen, Dean, Farrow, Norma E., Mosca, Paul J., Lowe, Michael C., Farley, Clara R., Potdar, Aishwarya, Daou, Hala, Sun, James, Carr, Michael, Farma, Jeffrey M., Henderson, Michael A., Speakman, David, Serpell, Jonathan, Delman, Keith A., Smithers, B. Mark, Barbour, Andrew, Tyler, Douglas S., Coventry, Brendon J., Zager, Jonathan S., Thompson, John F.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-05-2020; Springer Nature B.V
• Subjects: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Australia; Chemotherapy, Cancer, Regional Perfusion - methods; Cytotoxicity; Dactinomycin - administration & dosage; Female; Humans; Length of Stay; Lower Extremity; Male; Medicine; Medicine & Public Health; Melanoma; Melanoma - drug therapy; Melanoma - pathology; Melanoma - secondary; Melphalan; Melphalan - administration & dosage; Metastases; Metastasis; Neoplasm Metastasis; Neoplasm Staging; Neoplasm, Residual; Nonagenarian; Oncology; Progression-Free Survival; Skin Neoplasms - drug therapy; Skin Neoplasms - pathology; Skin Neoplasms - secondary; Surgery; Surgical Oncology; Survival; Treatment Outcome; Tumor Burden; United States; Upper Extremity; Australia; United States
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-020-08312-0

Background
Isolated limb infusion (ILI) is used to treat in-transit melanoma metastases confined to an extremity. However, little is known about its safety and efficacy in octogenarians and nonagenarians (ON).
Patients and Methods
ON patients (≥ 80 years) who underwent a first ILI for American Joint Committee on Cancer seventh edition stage IIIB/IIIC melanoma between 1992 and 2018 at nine international centers were included and compared with younger patients (< 80 years). A cytotoxic drug combination of melphalan and actinomycin-D was used.
Results
Of the 687 patients undergoing a first ILI, 160 were ON patients (median age 84 years; range 80–100 years). Compared with the younger cohort (
n
 = 527; median age 67 years; range 29–79 years), ON patients were more frequently female (70.0% vs. 56.9%;
p
 = 0.003), had more stage IIIB disease (63.8 vs. 53.3%;
p
 = 0.02), and underwent more upper limb ILIs (16.9% vs. 9.5%;
p
 = 0.009). ON patients experienced similar Wieberdink limb toxicity grades III/IV (25.0% vs. 29.2%;
p 
= 0.45). No toxicity-related limb amputations were performed. Overall response for ON patients was 67.3%, versus 64.6% for younger patients (
p
 = 0.53). Median in-field progression-free survival was 9 months for both groups (
p
 = 0.88). Median distant progression-free survival was 36 versus 23 months (
p
 = 0.16), overall survival was 29 versus 40 months (
p
 < 0.0001), and melanoma-specific survival was 46 versus 78 months (
p
 = 0.0007) for ON patients compared with younger patients, respectively.
Conclusions
ILI in ON patients is safe and effective with similar response and regional control rates compared with younger patients. However, overall and melanoma-specific survival are shorter.