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Teras J , Kroon HM , Miura JT , Kenyon-Smith T , Beasley GM , Mullen D , Farrow NE , Mosca PJ , Lowe MC , Farley CR , Potdar A , Daou H , Sun J , Carr M , Farma JM , Henderson MA , Speakman D , Serpell J , Delman KA , Smithers BM , Barbour A , Tyler DS , Coventry BJ , Zager JS , Thompson JF
International Multicenter Experience of Isolated Limb Infusion for In-Transit Melanoma Metastases in Octogenarian and Nonagenarian Patients
Ann Surg Oncol. 2020 May;27(5) :1420-1429
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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.
1534-4681 Teras, Juri 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 Journal Article United States Ann Surg Oncol. 2020 Mar 9. pii: 10.1245/s10434-020-08312-0. doi: 10.1245/s10434-020-08312-0.