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. 2019 Apr;26(4):1055-1062.
doi: 10.1245/s10434-018-07143-4. Epub 2019 Jan 7.

Response and Toxicity of Repeated Isolated Limb Perfusion (re-ILP) for Patients With In-Transit Metastases of Malignant Melanoma

Valerio Belgrano  1   2 , Jessica Pettersson  1 , Jonas A Nilsson  2 , Jan Mattsson  1 , Dimitrios Katsarelias  1 , Roger Olofsson Bagge  3
Affiliations

Response and Toxicity of Repeated Isolated Limb Perfusion (re-ILP) for Patients With In-Transit Metastases of Malignant Melanoma

Valerio Belgrano et al. Ann Surg Oncol. 2019 Apr.

Abstract

Background: Isolated limb perfusion (ILP) is a safe and well-established treatment for in-transit metastases of melanoma. In case of relapse or disease progression, ILP can be repeated (re-ILP). This study aimed retrospectively to analyze a large consecutive series of re-ILP and compare clinical outcomes with first-time ILP.

Method: Between 2001 and 2015, 290 consecutive patients underwent 380 ILPs. Of these, 90 were re-ILPs including 68 second ILPs, 16 third ILPs, 4 fourth ILPs, and two fifth ILPs. The study evaluated response (using World Health Organization [WHO] criteria), local toxicity (using the Wieberdink scale), and complications (using Clavien-Dindo).

Results: The results were compared between the first ILP, the second ILP, and the third to fifth ILP. The overall response rate was respectively 83%, 80% and 68%, with a complete response (CR) rate of 60%, 41%, and 59%. In the re-ILP group, the patients with a CR after the first ILP had a 65% CR rate after the second ILP compared with 8% for the patients without a CR (p = 0.001). The risk for local toxicity or complications was not increased after re-ILP. The median overall survival periods were respectively 34, 41, and 93 months (p = 0.02).

Conclusion: As a therapeutic option, ILP can be repeated safely for in-transit metastases of melanoma, achieving similar high response rates without increasing complications or toxicity. Re-ILP is mainly indicated for patients who already had a CR after the first ILP, whereas other treatment options should be considered for primary non-responders.

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Figures

Fig. 1
Fig. 1
Diagram of repeated isolated limb perfusion (ILP) (re-ILP) divided by complete response (CR) or no CR
Fig. 2
Fig. 2
Overall survival. Median overall survival differed significantly depending on whether the patients were treated with one isolated limb perfusion (ILP) (34 months), two ILPs (41 months), or three to five ILPs (93 months) (p = 0.02)
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